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老年人社会支持网络规模与接受白内障手术之间的关联

Association of Social Support Network Size With Receipt of Cataract Surgery in Older Adults.

作者信息

Stagg Brian C, Choi HwaJung, Woodward Maria A, Ehrlich Joshua R

机构信息

Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.

National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.

出版信息

JAMA Ophthalmol. 2018 Apr 1;136(4):423-427. doi: 10.1001/jamaophthalmol.2018.0244.

Abstract

IMPORTANCE

Cataract-related vision impairment is an important public health issue that tends to affect older adults. Little is known about the association between older adults' social support networks and their likelihood of receiving cataract surgery.

OBJECTIVE

To determine if older adults with smaller social support networks are less likely to receive cataract surgery.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study. The National Health and Aging Trends Study, a nationally representative US survey, administered annually from 2011 to 2015 to a cohort of Medicare beneficiaries 65 years and older with no cataract surgery prior to the start of the study.

MAIN OUTCOMES AND MEASURES

Multivariable logistic regression was performed to evaluate if the number of persons in an individual's social support network influenced whether that individual received cataract surgery during a given year of the study.

RESULTS

Overall, 3448 participants were interviewed from 2011 to 2015 for a total of 9760 observations. Of these observations, 3084 (weighted, 38.81%; 95% CI, 37.28-40.35) were aged 70 to 74 years, 5211 (weighted, 52.32%; 95% CI, 50.19-54.44) were women; 5899 (weighted, 78.53%; 95% CI, 76.29-80.61) were white, 2249 (weighted, 9.55%; 95% CI, 8.45-10.78) were black, 537 (weighted, 7.18%; 95% CI, 5.88-8.73) were Hispanic, and 303 (weighted, 4.74%; 95% CI, 3.56-62.9) reported other races. Medicare beneficiaries with smaller social support networks (0-2 individuals) were less likely to receive cataract surgery in a given year (adjusted odds ratio, 0.60; 95% CI, 0.37-0.96) than those with larger support networks (≥3 individuals). The adjusted predicted proportion of Medicare beneficiaries undergoing cataract surgery was 4.7% (95% CI, 2.7%-6.7%) and 7.5% (95% CI, 6.9%-8.1%) for those with small and large social support networks, respectively. Having fewer non-spouse/partner family members in the support network was associated with decreased odds of receiving cataract surgery (adjusted odds ratio, 0.60; 95% CI, 0.43-0.85), but having spouses/partners (adjusted odds ratio, 0.97; 95% CI, 0.77-1.22) and nonfamily members (adjusted odds ratio, 0.90; 95% CI, 0.72-1.11) did not have a significant association.

CONCLUSIONS AND RELEVANCE

Medicare beneficiaries with fewer non-spouse/partner family members in their social support networks were less likely to receive cataract surgery. These findings suggest that attention should be given to patients with smaller support networks to ensure that they receive cataract surgery when it is indicated.

摘要

重要性

与白内障相关的视力损害是一个重要的公共卫生问题,往往影响老年人。关于老年人的社会支持网络与其接受白内障手术可能性之间的关联,人们了解甚少。

目的

确定社会支持网络较小的老年人接受白内障手术的可能性是否较低。

设计、设置和参与者:回顾性队列研究。美国国家健康与老龄化趋势研究是一项具有全国代表性的调查,于2011年至2015年每年对一组年龄在65岁及以上且在研究开始前未接受过白内障手术的医疗保险受益人进行调查。

主要结局和测量指标

进行多变量逻辑回归分析,以评估个人社会支持网络中的人数是否会影响该个体在研究给定年份接受白内障手术的情况。

结果

总体而言,2011年至2015年共采访了3448名参与者,总计9760次观察。在这些观察中,3084人(加权后为38.81%;95%置信区间为37.28 - 40.35)年龄在70至74岁之间,5211人(加权后为52.32%;95%置信区间为50.19 - 54.44)为女性;5899人(加权后为78.53%;95%置信区间为76.29 - 80.61)为白人,2249人(加权后为9.55%;95%置信区间为8.45 - 10.78)为黑人,537人(加权后为7.18%;95%置信区间为5.88 - 8.73)为西班牙裔,303人(加权后为4.74%;95%置信区间为3.56 - 62.9)报告为其他种族。社会支持网络较小(0 - 2人)的医疗保险受益人在给定年份接受白内障手术的可能性低于社会支持网络较大(≥3人)者(调整后的优势比为0.60;95%置信区间为0.37 - 0.96)。社会支持网络较小和较大的医疗保险受益人接受白内障手术的调整后预测比例分别为4.7%(95%置信区间为2.7% - 6.7%)和7.5%(95%置信区间为6.9% - 8.1%)。支持网络中非配偶/伴侣家庭成员较少与接受白内障手术的几率降低相关(调整后的优势比为0.60;95%置信区间为0.43 - 0.85),但有配偶/伴侣(调整后的优势比为0.97;95%置信区间为0.77 - 1.22)和非家庭成员(调整后的优势比为0.90;95%置信区间为0.72 - 1.11)则无显著关联。

结论与相关性

社会支持网络中非配偶/伴侣家庭成员较少的医疗保险受益人接受白内障手术的可能性较低。这些发现表明,应关注支持网络较小的患者,以确保他们在有指征时能接受白内障手术。

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