Challenges Assessing Disparities in Patients Discharged After Firearm-Associated Ocular Injury

Abstract

Disparities in patient care occur across a broad range of dimensions, including socioeconomic status, race and ethnicity, age, geography, language, gender, disability status, citizenship status, and sexual identity and orientation. Vulnerable patients face challenges in accessing equitable care, proper follow-up visits, and evidence-based management, which ultimately leads to worse health outcomes. In the field of ocular trauma, disparities in discharge patterns and visual outcomes have been reported in research. [1][2][3] A prior study 2 investigating older patients with ocular trauma found that Black, Hispanic, male, and self-paying patients were disproportionately discharged home. Knowing that ocular trauma due to gunshot wounds can lead to long-term visual damage outcomes, 3 in-depth analyses of patient discharge patterns after firearm-associated ocular injury (FAOI) can elucidate underlying disparities in care.A recent study in this issue of JAMA Ophthalmology by Mike et al 1 reports disparities in discharges to an advanced care facility (ACF) after being admitted with FAOI in the US. Using the National Trauma Data Bank (NTDB), Mike et al 1 determined that 235 254 patients were admitted with firearm injuries from 2008 to 2014, of which 8715 (3.7%) involved the eyes. By performing a multivariate analysis on this sample of patients affected by FAOI, the study found that factors like longer hospital stay, older age, associated traumatic brain injury (TBI), severe TBI, and very severe injury using the Injury Severity Score (ISS), White race, and insurance via Medicare had the highest odds of ACF placements. These findings are consistent with prior studies investigating discharge patterns after admission for ocular injuries, TBI, and trauma. 2,4 The study authors point out that disparities in disposition after FAOI may restrict the ability of certain groups to achieve their full rehabilitation potential but acknowledge the need for additional research to confirm their findings and understand the underlying reasons for such disparities. Ultimately, understanding these disparities will assist in developing guidelines for appropriate and equitable post-FAOI rehabilitation for all.Study limitations arise from the decision to use the NTDB. Indeed, approaching this database retrospectively constrained the information analyzed. The study's data were limited to 2008 to 2014, which means that they may not be representative of current trends in ocular trauma care. More recent data would be warranted to confirm the study's findings. Additionally, the study was solely based on patients in the US, which means that the findings may not be generalizable to other countries. Due to the NTDB's nature, only patients from designated trauma centers are included, which means that the study findings may not be representative of the broader population of patients with FAOI. As the designation process of trauma