Abstract
Purpose :
To examine associations between Centers for Disease Control and Prevention Social Vulnerability Index (SVI) score, dual Medicare/Medicaid eligibility (DMME), and neovascular glaucoma (NVG) in at-risk beneficiaries in the 2019 California (CA) Medicare population.
Methods :
The study population included all 2019 CA Medicare beneficiaries ≥65 years old with Part A and Part B coverage and at least one Part B claim, with a history of retinal ischemia (proliferative diabetic retinopathy, retinal vein occlusion, ocular ischemic syndrome). Beneficiaries missing SVI scores were excluded. The exposures were SVI quartile and DMME. The outcome was NVG prevalence based on claims. Covariates included age, sex, race and ethnicity, and Charlson Comorbidity Index (CCI) score. Logistic regression was conducted to examine associations between SVI quartile, DMME, and prevalence of NVG. These included univariable models, partially adjusted models with demographics (age, sex, race and ethnicity) only and CCI only, and fully adjusted models with all covariates.
Results :
There were 41,976 CA Medicare beneficiaries in 2019 with retinal ischemic disease, of whom 1,843 (4.4%) had NVG and 17,508 (41.7%) had DMME. In unadjusted analyses, higher (more vulnerable) SVI quartiles and DMME were associated with increased odds of NVG (odds ratio [OR]=1.37, 95% confidence interval [CI]=1.20, 1.56 for SVI Q4 vs. Q1; OR=1.23, 95% CI=1.12, 1.35 for DMME). In demographics-adjusted analyses, there were no statistically significant associations between any SVI quartile (OR=1.13, 95% CI=0.98, 1.31 for Q4 vs. Q1) or DMME (OR=1.07, 95% CI=0.96, 1.20) and NVG. In CCI-adjusted analyses, higher SVI quartile (OR=1.31, 95% CI=1.15, 1.49 for Q4 vs. Q1) and DMME (OR=1.18, 95% CI=1.07, 1.30) were associated with increased odds of NVG. In fully adjusted analyses, there were no statistically significant associations between SVI quartile, DMME, and NVG.
Conclusions :
In the 2019 CA Medicare population, low socioeconomic status as measured by high SVI and DMME was only associated with increased likelihood of NVG before adjustment for demographic factors. Further studies are needed to determine whether disparities in the prevalence of NVG are driven by differential management of retinal ischemia in at-risk individuals based on age, sex, and race and ethnicity, independent of socioeconomic status.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.