Abstract
Purpose :
“Big data” analysis of electronic health records (EHRs) offers great potential for studying ocular disease. The VA Informatics and Computing Infrastructure (VINCI) contains over 20 years of EHR data on patients enrolled in the Veterans Health Administration (VHA), the largest integrated healthcare system in the U.S. This study examined Veterans with strabismus and how demographic factors may influence diagnosis and delivery of care.
Methods :
EHR records were queried with databasing tools in R studio software through VINCI. Strabismus diagnoses in VHA Veterans ≥18 years during 2000-2022 were identified by: 1. An International Classification of Diseases (ICD) code for a strabismus diagnosis or 2. A Current Procedural Terminology (CPT) code specific to strabismus surgery, even with no ICD diagnosis. Demographic data on age, sex, race, and ethnicity were collected. VHA enrollment data for VA fiscal years 2000-2022 were used to calculate total and demographic-stratified prevalence and incidence rates. Demographic differences in prevalence, incidence, rate of surgery, and types of strabismus were compared using a Wilcoxon Signed Rank or Friedman Test, Fisher Exact Test, and Chi-Square test, respectively (significance at corrected p ≤0.05).
Results :
A strabismus diagnosis was found for 321,639 Veterans (CPT code only = 1532), of whom 7399 had strabismus surgery. Annual prevalence was highest at 2.29% in VA fiscal year 2022; the median annual incidence rate was 168.9/100,000. Heterophoria was most common strabismus type, followed by exotropia. Prevalence and incidence rates varied significantly by demographic (p <0.0001 for both by age, race and ethnicity; p <0.001 for prevalence by sex). Likelihood of surgery in strabismus patients also varied by the demographic (p = 0.046 for likelihood of strabismus surgery by sex, p <0.001 for all others).
Conclusions :
Using a big data analysis of VHA health records, we have described the prevalence and incidence of strabismus in Veterans. We have demonstrated that strabismus prevalence differs sex and both prevalence and incidence differ by age, race and ethnicity. Despite having low prevalence and incidence, African American Veterans with strabismus were more likely to have surgery than Veterans of other races. Studies to identify the factors driving these findings are ongoing.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.