Association between glaucoma surgery and all-cause and cause-specific mortality among elderly patients with glaucoma: a nationwide population-based cohort study

Lee, Sang Yeop; Lee, Hun; Lee, Ji Sung; Han, Sol Ah; Kim, Yoon Jeon; Kim, Jae Yong; Tchah, Hungwon

doi:10.1038/s41598-021-96063-7

Cited by 7 publications

(5 citation statements)

References 44 publications

(29 reference statements)

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“…Interestingly, the association of mortality and vitrectomy among the patients with vitreoretinal diseases differed from those of mortality and cataract or glaucoma surgery in patients with cataract or glaucoma. While mortality due to pulmonary causes was decreased following vitrectomy, according to our previous studies examining mortality after cataract surgery and glaucoma surgery ( 17 , 18 ), all-cause mortality and mortality due to vascular and neurologic causes decreased in the cataract surgery group. On the other hand, all-cause mortality and, in particular, mortality from neurologic causes, increased in the glaucoma surgery group.…”

Section: Discussionmentioning

confidence: 71%

Vitrectomy and All-Cause and Cause-Specific Mortality in Elderly Patients With Vitreoretinal Diseases: A Nationwide Cohort Study

Kim

Lee

et al. 2022

Front. Med.

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PurposeTo determine the all-cause and cause-specific mortality in elderly patients with vitreoretinal diseases based on vitrectomy status.MethodsElderly patients (aged ≥ 60 years) diagnosed with vitreoretinal diseases between 2003 and 2012 using the Korean National Health Insurance Service-Senior cohort (2002–2015) were included in this nationwide population-based retrospective cohort study. The exposure of interest was vitrectomy, and information on mortality from patient inclusion until December 2015 was obtained. Cox regression modeling was used to assess the association between vitrectomy and mortality. An additional subgroup analysis was performed to investigate the effects of the underlying retinal disease characteristics and comorbidities on mortality.ResultsThe study cohort included 152,283 patients (3,313 and 148,970 in the vitrectomy and non-vitrectomy groups, respectively). The adjusted model showed vitrectomy was associated with a decreased risk of pulmonary-cause mortality [hazard ratio (HR), 0.51; P < 0.001]; however, no association was observed for all-cause mortality (HR, 0.93; P = 0.325). Vitrectomy was associated with increased mortality risk (all-cause: HR, 1.26; P < 0.001 and vascular causes: HR, 1.41; P = 0.003) among patients with retinal vascular diseases and decreased mortality risk (all-cause: HR, 0.64; P < 0.001 and pulmonary causes: HR, 0.35; P = 0.011) among patients with macular diseases. There were significant interactions between age and vitrectomy with respect to all-cause mortality among patients with either vitreoretinal disease.ConclusionsIn elderly patients with retinal diseases, the vitrectomy group showed the lower mortality from pulmonary causes with no association for all-cause mortality.

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Section: Discussionmentioning

confidence: 71%

Vitrectomy and All-Cause and Cause-Specific Mortality in Elderly Patients With Vitreoretinal Diseases: A Nationwide Cohort Study

Kim

Lee

et al. 2022

Front. Med.

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“…Significantly decreased surgical rates with increasing age by crude OR may be explained by the reluctance of elderly patients to agree to surgery due to fear of blindness or death, as well as a higher provider threshold to offer surgery. 25 However, with newer, advanced surgical techniques that result in lower intraoperative and postoperative risks, age should not serve as a sole limiting factor in glaucoma management options. 26 Another sociodemographic factor associated with lower odds of having surgical intervention was the female sex by crude OR.…”

Section: Discussionmentioning

confidence: 99%

“…Differences in surgical glaucoma care were further evident by additional Medicare beneficiary characteristics. Significantly decreased surgical rates with increasing age by crude OR may be explained by the reluctance of elderly patients to agree to surgery due to fear of blindness or death, as well as a higher provider threshold to offer surgery 25 . However, with newer, advanced surgical techniques that result in lower intraoperative and postoperative risks, age should not serve as a sole limiting factor in glaucoma management options 26 .…”

Section: Discussionmentioning

confidence: 99%

National Utilization of Glaucoma Laser and Surgical Management in Medicare Beneficiaries: Disparities and Accessibility

Gold

Yadollahikhales

Dersu

2023

Journal of Glaucoma

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Precis In this population-based, cross-sectional study of Medicare beneficiaries, there were lower odds of national glaucoma surgery among ages older than 85, female sex, Hispanic ethnicity, and diabetic comorbidity. Glaucoma surgery rates were independent of ophthalmologist distribution. Purpose: With an increasing prevalence of glaucoma in the United States, it is crucial to elucidate surgical procedure accessibility to deliver quality care. The objective of this study was to estimate national access to surgical glaucoma care by (1) comparing diagnostic and surgical management Medicare insurance claims followed by (2) correlating Medicare treatment claims with regional ophthalmologist availability. Patients and Methods: This cross-sectional study included Medicare claims from the 2017 Vision and Eye Health Surveillance System (VEHSS) and workforce data from the 2017 Area Health Resource Files (AHRF), both public domain databases. A total of 25,443,400 beneficiaries fully enrolled in Medicare Part B Fee-for-Service with glaucoma diagnosis claims were included. Rates of US MD ophthalmologists were determined by AHRF distribution densities. Surgical glaucoma management rates included Medicare service utilization claims for drain, laser, and incisional glaucoma surgery. Results: While Black, non-Hispanic Americans had the highest prevalence of glaucoma, Hispanic beneficiaries had the highest odds of surgery. Older age (85+ vs. 65–84 y; Odds Ratio [OR]=0.864; 95% Confidence Interval [CI], 0.854–0.874), female sex (OR=0.923; 95% CI, 0.914–0.932), and having diabetes (OR=0.944; 95% CI, 0.936–0.953) was associated with lower odds of having a surgical glaucoma intervention. Glaucoma surgery rates were not associated with ophthalmologist density by state. Conclusions: Glaucoma surgery utilization differences by age, sex, race/ethnicity, and systemic comorbidities warrant further investigation. Glaucoma surgery rates are independent of ophthalmologist distribution by state.

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“…The crude mortality rate for the elderly in Spain was 3,824 deaths per 100,000 inhabitants aged 75-84 (2017) [2]. Factors such as socioeconomic level [3], frailty [4], physical activity [5,6], self-rated health status [7], social and family support [8], chronic diseases [9,10], multimorbidity [11], nutritional status [12], body mass index [11], and cognitive function [13] may influence mortality rates. However, it is unknown whether any homeostatic factor that influences the degree of control of chronic diseases may be associated with an increased all-cause mortality in the elderly population.…”

Section: Introductionmentioning

confidence: 99%

Effect of glucose variability on the mortality of adults aged 75 years and over during the first year of the COVID-19 pandemic

Salinero-Fort,

San Andrés-Rebollo,

Cárdenas-Valladolid

et al. 2024

BMC Geriatr

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Background To our knowledge, only one study has examined the association between glucose variability (GV) and mortality in the elderly population with diabetes. GV was assessed by HbA1c, and a J-shaped curve was observed in the relationship between HbA1c thresholds and mortality. No study of GV was conducted during the COVID-19 pandemic and its lockdown. This study aims to evaluate whether GV is an independent predictor of all-cause mortality in patients aged 75 years or older with and without COVID-19 who were followed during the first year of the COVID-19 pandemic and its lockdown measures. Methods This was a retrospective cohort study of 407,492 patients from the AGED-MADRID dataset aged 83.5 (SD 5.8) years; 63.2% were women, and 29.3% had diabetes. GV was measured by the coefficient of variation of fasting plasma glucose (CV-FPG) over 6 years of follow-up (2015–2020). The outcome measure was all-cause mortality in 2020. Four models of logistic regression were performed, from simple (age, sex) to fully adjusted, to assess the effect of CV-FPG on all-cause mortality. Results During follow-up, 34,925 patients died (14,999 women and 19,926 men), with an all-cause mortality rate of 822.3 per 10,000 person-years (95% confidence interval (CI), 813.7 to 822.3) (739 per 10,000; 95% CI 728.7 to 739.0 in women and 967.1 per 10,000; 95% CI 951.7 to 967.2 in men). The highest quartile of CV-FPG was significantly more common in the deceased group (40.1% vs. 23.6%; p < 0.001). In the fully adjusted model including dementia (Alzheimer’s disease) and basal FPG, the odds ratio for mortality ranged from 1.88 to 2.06 in patients with T2DM and from 2.30 to 2.61 in patients with normoglycaemia, according to different sensitivity analyses. Conclusions GV has clear implications for clinical practice, as its assessment as a risk prediction tool should be included in the routine follow-up of the elderly and in a comprehensive geriatric assessment. Electronic health records can incorporate tools that allow its calculation, and with this information, clinicians will have a broader view of the medium- and long-term prognosis of their patients.

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Association between glaucoma surgery and all-cause and cause-specific mortality among elderly patients with glaucoma: a nationwide population-based cohort study

Cited by 7 publications

References 44 publications

Vitrectomy and All-Cause and Cause-Specific Mortality in Elderly Patients With Vitreoretinal Diseases: A Nationwide Cohort Study

Vitrectomy and All-Cause and Cause-Specific Mortality in Elderly Patients With Vitreoretinal Diseases: A Nationwide Cohort Study

National Utilization of Glaucoma Laser and Surgical Management in Medicare Beneficiaries: Disparities and Accessibility

Effect of glucose variability on the mortality of adults aged 75 years and over during the first year of the COVID-19 pandemic

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