Risk Factors Predicting Loss to Follow-Up, Medication Noncompliance, and Poor Visual Outcomes Among Patients With Infectious Keratitis at a Public County Hospital

Lopez, Jacqueline B.; Chan, Lawrence; Saifee, Murtaza; Padmanabhan, Sriranjani; Yung, Madeline; Chan, Matilda F.

doi:10.1097/ico.0000000000003121

Cited by 3 publications

(5 citation statements)

References 15 publications

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“…Our group previously reported an association of non-White race (Asian, Black, and other races) with decreased count of diagnostic and therapeutic procedures for MK (difference in the logs of expected counts,−1.3; 95% CI, −2.60 to 0.05; P = 0.05) and decreased count of visits, emails, and phone calls for MK (difference in the logs of expected counts, −0.58; 95% CI, −1.1 to −0.04; P = .03) compared with White race in a sample of 69 patients with MK. Another study found that race was not associated with final BCVA (measurement on the visit where epithelial defect was stated to be healed or if the patient was lost to follow-up, their final visit) in patients with MK. Our study also found a smaller percentage of Hispanic patients had presenting BCVA worse than 20/40 as compared with non-Hispanic patients (39.8% vs. 54.4%; P = .04).…”

Section: Discussionmentioning

confidence: 99%

“…18,27,[38][39][40] Specifically, patients with MK with presenting BCVA worse than 20/40 were older compared with those with better BCVA (≥20/ 40). Parmar and colleagues 39 found that a larger percentage 28 found that race was not associated with final BCVA (measurement on the visit where epithelial defect was stated to be healed or if the patient was lost to followup, their final visit) in patients with MK. Our study also found a smaller percentage of Hispanic patients had presenting BCVA worse than 20/40 as compared with non-Hispanic patients (39.8% vs. 54.4%; P = .04).…”

Section: Discussionmentioning

confidence: 99%

“…Further, if they reside in a neighborhood with less transportation options and limited specialized pharmacies, these neighborhood factors compound the problem. The effect of SRFs on acute conditions, such MK, has been limited …”

Section: Introductionmentioning

confidence: 99%

“…The effect of SRFs on acute conditions, such MK, has been limited. 27,28 The purpose of this study was to understand if neighborhoodlevel SRFs were associated with severity of MK at clinical presentation, as measured by visual acuity, after adjusting for individual-level sociodemographic factors. The goal was to identify SDOH targets for policy change to mitigate the downstream outcomes of eye health.…”

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confidence: 99%

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Social Risk Factor Associations With Presenting Visual Acuity in Patients With Microbial Keratitis

et al. 2023

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ImportanceNeighborhood-level social risk factors may contribute to health disparities in microbial keratitis (MK) disease presentation. Understanding neighborhood-level factors may identify areas for revised health policies to address inequities that impact eye health.ObjectiveTo investigate if social risk factors were associated with presenting best-corrected visual acuity (BCVA) for patients with MK.Design, Setting, and ParticipantsThis was a cross-sectional study of patients with a diagnosis of MK. Patients presenting to the University of Michigan with a diagnosis of MK between August 1, 2012, and February 28, 2021, were included in the study. Patient data were obtained from the University of Michigan electronic health record.Main Outcomes and MeasuresIndividual-level characteristics (age, self-reported sex, self-reported race and ethnicity), presenting log of the minimum angle of resolution (logMAR) BCVA, and neighborhood-level factors, including measures on deprivation, inequity, housing burden, and transportation at the census block group, were obtained. Univariate associations of presenting BCVA (&lt; 20/40 vs ≥20/40) with individual-level characteristics were assessed with 2-sample t, Wilcoxon, and χ2 tests. Logistic regression was used to test associations of neighborhood-level characteristics with the probability of presenting BCVA worse than 20/40 after adjustment for patient demographics.ResultsA total of 2990 patients with MK were identified and included in the study. Patients had a mean (SD) age of 48.6 (21.3) years, and 1723 were female (57.6%). Patients self-identified with the following race and ethnicity categories: 132 Asian (4.5%), 228 Black (7.8%), 99 Hispanic (3.5%), 2763 non-Hispanic (96.5%), 2463 White (84.4%), and 95 other (3.3%; included any race not previously listed). Presenting BCVA had a median (IQR) value of 0.40 (0.10-1.48) logMAR units (Snellen equivalent, 20/50 [20/25-20/600]), and 1508 of 2798 patients (53.9%) presented with BCVA worse than 20/40. Patients presenting with logMAR BCVA less than 20/40 were older than those who presented with 20/40 or higher (mean difference, 14.7 years; 95% CI, 13.3-16.1; P &lt; .001). Furthermore, a larger percentage of male vs female sex patients presented with logMAR BCVA less than 20/40 (difference, 5.2%; 95% CI, 1.5-8.9; P = .04), as well as Black race (difference, 25.7%; 95% CI, 15.0%-36.5%;P &lt; .001) and White race (difference, 22.6%; 95% CI, 13.9%-31.3%; P &lt; .001) vs Asian race, and non-Hispanic vs Hispanic ethnicity (difference, 14.6%; 95% CI, 4.5%-24.8%; P = .04). After adjusting for age, self-reported sex, and self-reported race and ethnicity, worse Area Deprivation Index (odds ratio [OR], 1.30 per 10-unit increase; 95% CI, 1.25-1.35; P &lt; .001), increased segregation (OR, 1.44 per 0.1-unit increase in Theil H index; 95% CI, 1.30-1.61; P &lt; .001), higher percentage of households with no car (OR, 1.25 per 1 percentage point increase; 95% CI, 1.12-1.40; P = .001), and lower average number of cars per household (OR, 1.56 per 1 less car; 95% CI, 1.21-2.02; P = .003) were associated with increased odds of presenting BCVA worse than 20/40.Conclusion and RelevanceFindings of this cross-sectional study suggest that in a sample of patients with MK, patient characteristics and where they live were associated with disease severity at presentation. These findings may inform future research on social risk factors and patients with MK.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Social Risk Factor Associations With Presenting Visual Acuity in Patients With Microbial Keratitis

et al. 2023

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“…This study presents positive associations between dementia, housing insecurity, and legal blindness with LOS. Housing insecurity has been previously implicated in higher rates of being lost to follow-up in patients with diabetic retinopathy and higher risk for treatment barriers such as medication noncompliance and delayed time to resolution in patients with infectious keratitis . In a previous large database study, the authors investigated the impact of housing insecurity on all hospitalizations in the US and found a trend toward longer LOS, although these results did not reach significance.…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic and Clinical Predictors of Prolonged Length of Corneal Ulcer Hospitalizations

Akosman,

Li,

Kwon

et al. 2024

JAMA Ophthalmol

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ImportanceThe length of stay (LOS) of hospitalizations may be a useful indicator of the burden of disease of corneal ulcers. Identifying variables associated with longer LOS may help to enhance delivery of care for high-risk patients.ObjectiveTo investigate the sociodemographic, social, and clinical factors associated with LOS in hospitalizations for corneal ulcers in the US.Design, Setting, and ParticipantsThis was a retrospective cross-sectional study of adult patients (aged &gt;18 years) admitted with a primary diagnosis of corneal ulcer between quarter 4 of 2015 through 2020 and conducted using data from the National Inpatient Sample (NIS). Patients were stratified into 2 even cohorts based on LOS: LOS of 4 days or less and LOS greater than 4 days. Individual-level sociodemographic, social risk factors, and medical comorbidities associated with longer LOS were examined by multivariable regression. Data were analyzed from October 2015 to December 2020.ExposurePotential sociodemographics or medical comorbidities at hospital admission.Main Outcome and MeasureThe primary outcome of interest was factors associated with extended length of stay. The hypothesis being tested was formulated during data collection.ResultsA total of 1187 patients (mean [SD] age, 53.5 [20.9] years; 602 female [50.7%]) were included for analysis. The cohort with LOS greater than 4 days had higher total charges than the cohort with LOS of 4 days or less (mean [SD] charges, $79 504 [$86 719] vs $26 474 [$20 743]; P &lt; .001). Sociodemographic variables associated with LOS greater than 4 days were Black race (adjusted odds ratio [aOR], 1.41; 95% CI, 1.03-1.92; P = .03), Medicare insurance (aOR, 1.42; 95% CI, 1.09-1.85; P = .009), and housing insecurity (aOR, 1.99; 95% CI, 1.29-3.06; P = .002). Medical comorbidities associated with LOS greater than 4 days were alcohol use (aOR, 1.50; 95% CI, 1.00-2.26; P = .05), dementia (aOR, 2.35; 95% CI, 1.36-4.07; P = .002), complicated diabetes (aOR, 1.75; 95% CI, 1.21-2.53; P = .003), uncomplicated diabetes (aOR, 1.57; 95% CI, 1.02-2.42; P = .04), drug misuse (aOR, 1.66; 95% CI, 1.08-2.57; P = .02), and legal blindness (aOR, 3.42; 95% CI, 1.19-9.82; P = .02). Based on NIS national estimates, corneal ulcers were estimated to have a direct annual health care expenditure of $35 819 590 in the US.Conclusion and RelevanceCorneal ulcer hospitalizations represent a significant burden of disease for patients and health care systems. This study highlights sociodemographic and clinical factors that may help clinicians identify high-risk patients vulnerable to complications and morbidity due to corneal ulcers.

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Characterization of Polymicrobial and Antibiotic-Resistant Infectious Keratitis in a County Hospital Setting

Chan,

Lopez,

Saifee

et al. 2023

Cornea Open

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Purpose: Infectious keratitis is a serious cause of visual impairment, particularly in low-income communities. This study examines the associations between social risk factors and polymicrobial keratitis, multidrug resistance, pathogen spectrum, and outcomes at a county hospital. Methods: We performed a retrospective study of Zuckerberg San Francisco General Hospital patients treated for infectious keratitis from 2010 to 2021. Multivariable regression was performed to analyze the relationships between social, medical, and psychiatric risk factors with polymicrobial growth, multidrug resistance, and clinical outcomes. Results: Of 174 patients with infectious keratitis, 44 (25%) had polymicrobial growth. Six patients (14%) with polymicrobial growth had multidrug-resistant organisms. Homeless patients were more likely to present with polymicrobial infection (odds ratio [OR] 3.4, P = 0.023), and polymicrobial infections were associated with multidrug-resistant organisms (P = 0.018). Smoking, drug use, HIV positivity, prior corneal pathology, and contact lens use were not associated with an increased risk of polymicrobial infection. Eleven patients (6.3%) were started on topical antibiotics before presentation; of these, none developed polymicrobial infections or multidrug-resistant organisms. Polymicrobial infections increased the likelihood to initiation of fortified antibiotics (OR 2.9, P = 0.011) but did not impact ulcer size, final visual acuity, time to resolution, or likelihood of emergent procedures. Conclusions: Homelessness correlates with an increased risk of polymicrobial keratitis and subsequent multidrug resistance, supporting initiation of broad antibiotic coverage in this population. Prior topical antibiotics did not increase risk of polymicrobial infection. Polymicrobial infection did not significantly worsen clinical outcomes.

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Risk Factors Predicting Loss to Follow-Up, Medication Noncompliance, and Poor Visual Outcomes Among Patients With Infectious Keratitis at a Public County Hospital

Cited by 3 publications

References 15 publications

Social Risk Factor Associations With Presenting Visual Acuity in Patients With Microbial Keratitis

Social Risk Factor Associations With Presenting Visual Acuity in Patients With Microbial Keratitis

Sociodemographic and Clinical Predictors of Prolonged Length of Corneal Ulcer Hospitalizations

Characterization of Polymicrobial and Antibiotic-Resistant Infectious Keratitis in a County Hospital Setting

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