Abstract
Purpose :
Glaucoma is associated with declines in function, including reduced mobility, slower reading speeds, and an increased risk of falls. This leads to adverse health-related (AHR) outcomes that significantly impact the overall quality of life among older adults, with added economic burden and increased morbidity and mortality. Our study seeks to determine the association of a glaucoma diagnosis with healthcare utilization and resource allocation.
Methods :
We used a 5% random sample of Medicare fee-for-service beneficiaries to identify individuals with and without a diagnosis of glaucoma in the subsequent 6 months after an eye exam. In a 1-1 propensity score (PS) matched cohort, we used negative binomial regression models to estimate incident rate ratios (IRR) assessing the association between glaucoma and these AHR outcomes over the subsequent 6 months: admission to skilled nursing facility (SNF), admission to long-term nursing home care, inpatient hospitalization (IH), and home health aide (HHA) use. Secondary analyses examined the association between severe glaucoma (based on ICD codes) and these AHR outcomes.
Results :
Among 89,136 Medicare beneficiaries with glaucoma, the mean age was 77.1 (SD 8.1), female beneficiaries constituted 58.4%, and 73.0% of beneficiaries were non-Hispanic White. For the PS matched cohort (n=89,136), mean age was 77.0 (SD 8.2), female beneficiaries constituted 58.4%, and 73.0% of beneficiaries were non-Hispanic White. Beneficiaries with glaucoma had higher rates of HHA use (IRR 1.07, 95% CI 1.04-1.10, p < 0.001) and SNF stays (IRR 1.05, 95% CI 1.02-1.08, p < 0.001). There were no statistically significant associations between glaucoma and IH encounters or stays in non-SNF homes (p > 0.10). Subgroup analyses showed that in comparison to controls, patients with severe glaucoma had higher rates of HHA use (IRR 1.28, 95% CI 1.18-1.38, p < 0.001), SNF admissions (IRR 1.24, 95% CI 1.15-1.34, p < 0.001), IH encounters (IRR 1.09, 95% CI 1.03-1.15, p < 0.005), and non-SNF care (IRR 1.14, 95% CI 1.03-1.26, p < 0.01).
Conclusions :
Glaucoma in Medicare beneficiaries aged >65 is associated with increased rates of adverse health-related outcomes, including higher use of SNF and home health aides. These findings underscore the substantial impact of glaucoma-related vision loss on healthcare utilization among Medicare recipients, emphasizing the need for tailored interventions and support.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.