Abstract
Purpose :
Previous studies have shown significant associations between socioeconomic and racial disparities in the treatment outcomes of eye diseases, including diabetic retinopathy and glaucoma. Utilizing data from the NIH All of Us national database, this analysis investigates the impact of social factors, such as race, income, and insurance status, on access to uveitis treatment, with a specific focus on the use of biologic drugs.
Methods :
ICD diagnosis codes were used to generate a cohort of patients with non-infectious uveitis (N = 3223). Additionally, within this cohort, patients with non-infectious uveitis who were treated with biologic drugs were tagged. Next, a multiple logistic regression analysis was conducted, assessing each social determinant independently, to understand its association with biologics administration. The covariates analyzed included race, sex, income, insurance status, and age.
Results :
Among 3223 patients, 269 (8.3%) received biologic drugs. Biologic treatment proportions varied across race, sex, income, and insurance status (Table 1).
Insured white males earning over $100K annually were the reference group (Table 2). Uninsured individuals showed the greatest decrease in biologic treatment (OR 0.22, p=0.034). Earning under $35K and between $35K-$50K also lowered the odds of receiving biologics (OR 0.64, p=0.018; OR 0.55, p=0.040). African American and Hispanic patients had reduced treatment with biologics (OR 0.54, p<0.001; OR 0.60, p=0.013). Females were more likely to receive treatment (OR 1.45, p=0.009). Increasing age correlated with lower biologics use (OR 0.98, p<0.001).
Conclusions :
These findings suggest that insurance status has the strongest association in the differential administration of biologic drugs in uveitis treatment, highlighting this as a key area for intervention from a public health perspective. Moreover, while individuals earning under $35K experience treatment disparities, those in the $35K-$50K income range face more pronounced disparities, showing that these issues extend beyond income levels traditionally associated with poverty. Additionally, African American and Hispanic patients are less likely to receive biologic treatments for non-infectious uveitis, suggesting deeper underlying disparities and opportunities for further research.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.