Assessment of Health Disparities and Barriers to Accessing Keratoconus and Crosslinking at a Tertiary Referral Center

Abstract

Methods: This was a prospective 1-year study of patients at Auckland District Health Board. Studied parameters included age, sex, body mass index, ethnicity, New Zealand Deprivation (NZDep; an area-based measure of socioeconomic status, 1 = low deprivation-10 = high deprivation) score of residence, disease severity (maximum keratometry and thinnest corneal thickness), attendance, distance travelled, car ownership, employment status, and visual outcomes. Statistical analysis was performed using independent t tests, Pearson correlation, independent samples ANOVA, MANCOVA, and binomial logistic regression.Results: Four hundred fifty-four patients with keratoconus were analyzed and had a mean age of 24.1 6 0.8 years, mean body mass index of 33.0 6 9.7 kg/m 2 , and 43% were female. Pacific Peoples consisted 40.2% of the population; M aori 27.2%; Europeans 21.2%; Asian 9.9%; and Middle Eastern, Latin American, and African (MELAA) 1.3%. The mean distance travelled was 12.5 6 9.5 km, NZDep score was 6.8 6 2.6, and attendance was 69.0 6 42.5%. The lowest attendance was observed in Pacific Peoples (58.9%) and the highest was in Asians (90%) (P = 0.019). The mean worst-eye visual acuity at attendance was 0.75 6 0.47 logMAR (6/35). Unemployment was associated with worse best-eye visual acuity at FSA (P = 0.01) and follow-up (P , 0.05). M aori and Pacific Peoples had the highest NZDep (P , 0.001), were younger at presentation (P = 0.019), had higher disease severity (P , 0.001), and worse visual acuity (P , 0.001). Conclusions:Poor attendance was seen in this cohort. Pacific Peoples and M aori presented younger with worse disease severity and visual acuity but also had the highest nonattendance. These results suggest that deprivation, factors associated with ethnicity, and unemployment are potential barriers to attendance.