Abstract
Purpose :
To characterize differences in eye care utilization among patients with vision-threatening diabetic retinopathy by race/ethnicity and insurance status.
Methods :
Negative binomial regression analyses were performed to compare relative rates of eye care utilization among participants of different racial/ethnic groups in the All of Us dataset, stratified by insurance as a proxy for socioeconomic status.
Results :
Among 1,086 study participants, 32.9% self-identified as non-Hispanic White, 31.1% as non-Hispanic Black/African American, and 36.0% as Hispanic. 35.0% of the study cohort were enrolled in Medicaid. Overall, Black patients had lower outpatient visit rates (RR, 0.68; 95% confidence interval [CI], 0.55, 0.83) and higher laser photocoagulation rates (RR, 1.94; 95% CI, 1.28,2.97) when compared to White patients. When stratified by insurance status, disparities in visit rates between Black and White patients persisted among both the Medicaid (RR, 0.52; 95% CI, 0.32, 0.84) and non-Medicaid populations (RR, 0.72; 95% CI, 0.60, 0.93). Black patients covered under Medicaid additionally had lower rates of intravitreal injections (RR, 0.30; 95% CI, 0.03, 0.62). Black patients with non-Medicaid coverage exhibited double the rate of laser treatment (RR, 2.00; 95% CI, 1.20, 3.36) when compared to White patients with non-Medicaid coverage. Among Hispanic patients, those covered by Medicaid had lower rates of outpatient visits (RR, 0.63, 95% CI 0.39, 0.99) and intravitreal injections (RR 0.35, 95% CI 0.03, 0.72) when compared to White patients with Medicaid. Differences in utilization were not detected among Hispanic and White patients with non-Medicaid coverage.
Conclusions :
Overall, Black patients exhibited lower rates of eye care visits and higher rates of laser photocoagulation; this difference in visit rate persisted after stratification by insurance type. Insurance coverage was found to act as an effect modifier between race and utilization, with Black and Hispanic patients covered by Medicaid exhibiting lower rates of intravitreal injections and Hispanic patients with Medicaid exhibiting lower outpatient visit rates than White patients. Our findings illustrate the importance of developing care strategies that address both risk factor modification and social determinants of health to mitigate disparities in eye care utilization and outcomes.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.