Fraser S, Bunce C, Wormald R, Brunner E
Glaxo Department of Ophthalmic Epidemiology, Institute of Ophthalmology, University College London, London EC1V 2PD, UK.
BMJ. 2001 Mar 17;322(7287):639-43. doi: 10.1136/bmj.322.7287.639.
To identify socioeconomic risk factors for first presentation advanced glaucomatous visual field loss.
Hospital based case-control study with prospective identification of patients.
Three hospital eye departments.
Consecutive patients newly diagnosed with glaucoma (n=220). Cases (late presenters) were those presenting with advanced glaucoma (n=110), controls were those with early glaucoma (n=110).
Median underprivileged area scores were higher among late presenters (29.5; interquartile range 9.0-42.2) than in the control group (21.3; 6.1-37.4) (P=0.035). Late presenters were more likely to be of lower occupational class (odds ratio adjusted for age and referral centre 20.1 (95% confidence interval 2.6 to 155) for group III compared with group I-II and 86.0 (11.0 to 673 for group IV-V compared with group I-II), to have no access to a car (2.2; 1.2 to 4.0), to have left full time education at age 14 or less (7.5; 2.3 to 24.7), and to be tenants rather than owner occupiers (local authority tenants 3.2; 1.7 to 5.8, private tenants 2.1; 0.7 to 5.8). Effects of deprivation were partly accounted for by family history of glaucoma, time since last visit to an optometrist, and lack of an initial diagnosis of glaucoma by an optometrist.
Area and individual level deprivation were both associated with late presentation of glaucoma. Existing evidence shows that late presentation is an important risk factor for subsequent blindness. Deprived groups thus seem to be at greater risk of going blind from glaucoma. Material deprivation may be associated with more aggressive disease as well as later presentation.
确定初诊时出现晚期青光眼性视野缺损的社会经济风险因素。
基于医院的病例对照研究，对患者进行前瞻性识别。
三个医院眼科。
连续入选的新诊断青光眼患者（n = 220）。病例组（晚期就诊者）为患有晚期青光眼的患者（n = 110），对照组为早期青光眼患者（n = 110）。
晚期就诊者的贫困地区得分中位数（29.5；四分位间距9.0 - 42.2）高于对照组（21.3；6.1 - 37.4）（P = 0.035）。晚期就诊者更可能职业等级较低（与I - II组相比，III组经年龄和转诊中心调整后的比值比为20.1（95%置信区间2.6至155），与I - II组相比，IV - V组为86.0（11.0至673）），没有汽车（2.2；1.2至4.0），14岁及以下辍学（7.5；2.3至24.7），并且是租户而非自有住房者（地方当局租户为3.2；1.7至5.8，私人租户为2.1；0.7至5.8）。青光眼家族史、上次就诊验光师以来的时间以及验光师未进行青光眼初步诊断部分解释了贫困的影响。
地区和个体层面的贫困都与青光眼的晚期就诊有关。现有证据表明，晚期就诊是随后失明的重要风险因素。因此，贫困群体似乎因青光眼致盲的风险更大。物质贫困可能与更具侵袭性的疾病以及更晚就诊有关。
