Racial and Socioeconomic Differences in Eye Care Utilization among Medicare Beneficiaries with Glaucoma

Halawa, Omar A.; Kolli, Ajay; Oh, Gahee; Mitchell, William; Glynn, Robert J.; Kim, Dae; Friedman, David S.; Zebardast, Nazlee

doi:10.1016/j.ophtha.2021.09.022

Cited by 53 publications

(51 citation statements)

References 38 publications

(46 reference statements)

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“…Among patients with glaucoma, Black race has been associated with fewer outpatient visits, less testing, and more emergency department encounters compared to White race, even after accounting for socioeconomic status. Specifically, in a study of Medicare beneficiaries, Halawa et al [ 39 ] found race-related glaucoma disparities persisted between Black and White race within the same low socioeconomic status group in outpatient visits (relative risk [RR] 0.93; 95% CI 0.92–0.95), visual field testing (RR 0.96; 95% CI 0.94–0.98), optic nerve imaging (RR 0.81; 95% CI 0.78–0.83), and inpatient or emergency encounters (RR 2.57; 95% CI 1.55–4.26). Along the same lines, the Salisbury Eye Evaluation Study identified a sixfold higher rate of visual impairment from diabetic retinopathy among Black residents compared to their White peers [ 40 ].…”

Section: Social Determinants Of Vision Healthmentioning

confidence: 99%

Addressing Social Determinants of Vision Health

Williams

Sahel

2022

Ophthalmol Ther

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Social determinants of health encompass the quality of an individual’s social and physical environment and its effect on health outcomes. Disparities in these social and environmental factors have a significant role in vision health disparities and inequity in eye care. In this review, we discuss how disparities in visual impairment and eye care utilization are affected by each of the five core domains of social determinants of health, namely economic stability (income, employment, and food security), education (education level and health literacy), health care access (insurance and medical costs), neighborhood environment (housing conditions, home ownership, pollution, and crime), and social context (race and racism). Moreover, we describe a framework by which ophthalmologists can take action to address social determinants of vision health. These actionable strategies are guided by recommendations from the National Academies of Sciences, Engineering, and Medicine and have five complementary components to address social needs: awareness (screening for social needs), assistance (connecting patients with social care resources), adjustment (altering clinical care in recognition of social needs), alignment (understanding social assets and collaborating with community organizations), and advocacy (promoting policies to address social needs). Addressing social determinants of health is complex but achievable through collaborative strategies. Ophthalmologists have an important leadership role in addressing eye care disparities by taking action on underlying social determinants of vision health.

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Section: Social Determinants Of Vision Healthmentioning

confidence: 99%

Addressing Social Determinants of Vision Health

Williams

Sahel

2022

Ophthalmol Ther

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“…Glaucoma patients often do not experience symptoms until an advanced stage of glaucoma is reached, at which point, considerable optic nerve damage can be detected. Patients that are not consistently evaluated by a primary care physician, or do not receive annual eye care, are far more likely to be diagnosed at a later stage of the disease—this is frequently observed in patients with lower socioeconomic status (SES) [ 8 ]. Socioeconomic status is essentially a measure of an individual’s social status and economic class based on education, occupation, and income, and a higher SES is generally associated with better prevention of glaucoma progression [ 9 ].…”

Section: Socioeconomic Status and Racementioning

confidence: 99%

“…Eye care utilization varies across different racial populations. While black and Hispanic populations are shown to have both greater prevalence and stage of glaucoma, these populations have less outpatient ophthalmologic visits and preventative testing [ 8 ]. The lower frequencies of glaucoma testing in these populations are a result of inadequate access to preventative eye care, due to lower socioeconomic status.…”

Section: Socioeconomic Status and Racementioning

confidence: 99%

“…The lower frequencies of glaucoma testing in these populations are a result of inadequate access to preventative eye care, due to lower socioeconomic status. While preventative measures are utilized to a greater extent in non-Hispanic white patients, there is a higher prevalence in glaucoma procedures in black and Hispanic patients [ 8 ]. Medication adherence, a preventative measure in disease progression, is lower in black populations when compared to white patients [ 12 ].…”

Section: Socioeconomic Status and Racementioning

confidence: 99%

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Barriers to Care in the Treatment of Glaucoma: Socioeconomic Elements That Impact the Diagnosis, Treatment, and Outcomes in Glaucoma Patients

Musa

Bansal

Kaleem

2022

Curr Ophthalmol Rep

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“…By contrast, prior to the emergence of COVID-19, the rate-of-return was similar for White patients, compared with those identifying as other races and/or ethnicities at our medical center. Not surprisingly, COVID-19 acted as a barrier to care, exacerbating historic inequities, 17,18,21,[25][26][27][28] especially given that individuals from racial and/or ethnic minority groups were disproportionately affected by COVID-19 infections. 19 In view of the rapid transition required to make services possible for our patients during the COVID-19 pandemic, the finding that telehealth increased the rate at which diabetic patients returned for in-person eye examinations is an encouraging finding, especially with regard to those who had DR and worse vision.…”

Section: Discussionmentioning

confidence: 99%

Telehealth Encourages Patients with Diabetes in Racial and Ethnic Minority Groups to Return for in-Person Ophthalmic Care During the COVID-19 Pandemic

Ramsey¹,

Lasalle²,

Anjum³

et al. 2022

OPTH

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The COVID-19 pandemic had a disproportionate impact on patients from racial and/or ethnic minority groups, causing many to delay healthcare. This study evaluates the role telehealth visits played in helping patients with diabetes mellitus (DM) return for subsequent, in-person eye examinations after the outbreak of COVID-19. Methods: This retrospective, cross-sectional study analyzed 8147 patients with DM who had completed an outpatient ophthalmology and/or optometry visit in 2019 and who were due for return evaluation after the outbreak of COVID-19 in 2020. Factors associated with return for subsequent, in-person eye examination were assessed. Results: The mean age of patients was 68.8 (±13.0) years, and 42% were women. 7.4% of patients identified as Asian; 2.9% as Black; 3.4% as Hispanic or Latin American; 0.92%, as more than one race; 1.78%, as other races; and 80.7% as White. Patients from racial and/or ethnic minority groups completed fewer in-person eye examinations after the outbreak of COVID-19 compared with White patients (35.6% versus 44.5%, χ 2 =36.172, P<0.001). However, both groups accessed telehealth services at a similar rate during this period (21.1% versus 21.9%, χ 2 =0.417, P=0.518). Importantly, patients who received telehealth services returned for subsequent, inperson eye examinations at substantially higher rates, regardless of race (51.0% and 46.6%, respectively, χ 2 =1.840, P=0.175). This offset the otherwise lower rate of return experienced by patients from racial and/or ethnic minority groups compared with White patients among the group of patients who did not receive any telehealth services (32.7% versus 42.7%, χ 2 =36.582, P<0.001). The impact of telehealth on the likelihood of in-person return remained significant after taking into account age, gender, race, language, residence, severity of diabetic retinopathy (DR), and vision in a multivariate model. Conclusion:Telehealth initiatives benefited patients from racial and/or ethnic minority groups by reducing disparities in access to eye care experienced during the COVID-19 pandemic.

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Racial and Socioeconomic Differences in Eye Care Utilization among Medicare Beneficiaries with Glaucoma

Cited by 53 publications

References 38 publications

Addressing Social Determinants of Vision Health

Addressing Social Determinants of Vision Health

Barriers to Care in the Treatment of Glaucoma: Socioeconomic Elements That Impact the Diagnosis, Treatment, and Outcomes in Glaucoma Patients

Telehealth Encourages Patients with Diabetes in Racial and Ethnic Minority Groups to Return for in-Person Ophthalmic Care During the COVID-19 Pandemic

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