美国视网膜脱离修复中的性别差异。
Sex Differences in the Repair of Retinal Detachments in the United States.
机构信息
Byers Eye Institute at the Stanford University School of Medicine, Palo Alto, California, USA.
Byers Eye Institute at the Stanford University School of Medicine, Palo Alto, California, USA.
出版信息
Am J Ophthalmol. 2020 Nov;219:284-294. doi: 10.1016/j.ajo.2020.06.039. Epub 2020 Jul 5.
PURPOSE
To investigate differences between women and men in the repair of rhegmatogenous retinal detachments (RRDs) in the United States.
DESIGN
Retrospective cohort study.
METHODS
Setting: A large insurance claims database.
PARTICIPANTS
Subjects with an incident RRD between 2007 and 2015.
DATA
Demographic data, comorbid ocular conditions associated with RRD, systemic comorbidities, and surgical intervention (pneumatic retinopexy [PR], pars plana vitrectomy [PPV], laser barricade, or scleral buckle [SB]) were collected.
MAIN OUTCOME MEASURES
Odds of receipt of surgical intervention for incident RRD, time to repair, type of intervention, and the rate of reoperation by sex.
RESULTS
The study period included 133 million eligible records with 61,071 cases of incident RRD among which 43% (n = 26,289) were women. The primary outcome model had 23,933 confirmed RRD cases with a 93% retinal detachment repair rate. Women had 34% reduced odds of receipt of surgical repair of an RRD (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.59, 0.73; P < .001) after adjusting for confounders. This effect persisted in all sensitivity models. Among patients who received repair, women were more often delayed (0.17 days, P = .04). Women were more likely to undergo primary laser barricade (relative risk ratio [RRR] 1.68, P < .001), primary SB (RRR 1.15, P < .001), and PR (RRR 1.07, P < .04) than men. The odds of reoperation were lower in women (OR 0.91, 95% CI 0.85, 0.96; P = .002) after adjustment.
CONCLUSIONS
Insured women are less likely than insured men to receive surgical intervention for an RRD. Based on the results of this study, if the odds of repair were equal between women and men in the United States, then 781 more women would receive surgery each year, or 7,029 more during the study period. Women are more likely to have the repair performed with scleral buckle, laser barricade, and pneumatic retinopexy. The reason for these sex differences in RRD repair remains unknown and requires further investigation.
目的
在美国，调查女性和男性在孔源性视网膜脱离（RRD）修复方面的差异。
设计
回顾性队列研究。
方法
研究地点：一个大型保险索赔数据库。
参与者
2007 年至 2015 年间发生 RRD 的受试者。
数据
收集人口统计学数据、与 RRD 相关的合并眼部疾病、合并系统疾病以及手术干预（气压性视网膜固定术[PR]、玻璃体切除术[PPV]、激光屏障或巩膜扣带术[SB]）。
主要观察指标
RRD 发生率、手术干预时间、干预类型和性别导致的再次手术率。
结果
研究期间共纳入 1.33 亿份合格记录，其中有 61071 例 RRD 病例，其中 43%（n=26289）为女性。主要结局模型中，有 23933 例确诊 RRD 患者，视网膜脱离修复率为 93%。在调整混杂因素后，女性接受 RRD 手术修复的可能性降低 34%（优势比[OR]0.66，95%置信区间[CI]0.59，0.73；P<.001）。这种影响在所有敏感性模型中都持续存在。在接受修复的患者中，女性的延迟时间更长（0.17 天，P=0.04）。与男性相比，女性更倾向于接受初次激光屏障（相对风险比[RRR]1.68，P<.001）、初次 SB（RRR 1.15，P<.001）和 PR（RRR 1.07，P<.04）。女性再次手术的可能性较低（OR 0.91，95% CI 0.85，0.96；P=.002）。
结论
在美国，有保险的女性接受 RRD 手术治疗的可能性低于有保险的男性。基于本研究结果，如果美国女性和男性接受修复的可能性相同，那么每年将有 781 名女性接受手术治疗，或在研究期间将有 7029 名女性接受手术治疗。女性更有可能通过巩膜扣带术、激光屏障术和气压性视网膜固定术进行修复。RRD 修复中出现这些性别差异的原因尚不清楚，需要进一步研究。
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