Chilibeck Corina, Mathan Jeremy J, Ng Stephen Gj, McKelvie James
Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland.
Department of Ophthalmology Waikato District Health Board, Hamilton.
N Z Med J. 2020 Oct 30;133(1524):40-49.
To analyse the surgical intervention rate (SIR), best spectacle-corrected visual acuity (BSCVA) and disparities in access to public-funded cataract surgery in New Zealand. The New Zealand Ministry of Health uses the National Prioritisation Web Service (NPWS) to prioritise all patients for public-funded cataract surgery. BSCVA at prioritisation, ethnic, demographic and geographic disparities have not previously been assessed.
A retrospective cohort study. Between November 2014 and March 2019, 61,095 prioritisation events for 44,403 unique patients were identified. Cataract prioritisation events extracted from the NPWS were merged with date of birth and ethnicity extracted from the National Health Index database. All data were de-identified prior to statistical analysis.
Mean age at prioritisation was 74.4 years, with female preponderance (56%). Overall ethnicity was 'European' in 69.8% and 'New Zealand Māori' in 9.6%. Mean Snellen BSCVA was 6/30-2 (prioritised eye), and 6/12-1 (binocular). Māori and Pasifika presented on average 10 years earlier than other ethnic groups with significantly worse BSCVA. Surgery was approved in 74.4% of prioritisation events with mean Snellen BSCVA of 6/38-2. Only 34.9% of New Zealand patients had Snellen BSCVA of 6/12 or better in the prioritised eye, compared to 58.4% in the European Union. Cataract SIR varied by region.
New Zealand's cataract SIR is lower than most Organisation for Economic Co-operation and Development countries and patients have significantly worse BSCVA at prioritisation. Access to cataract surgery in New Zealand varies according to region. Māori and Pasifika present younger with worse BSCVA, suggesting potential barriers in accessing timely referral and prioritisation.
分析新西兰公费白内障手术的手术干预率（SIR）、最佳矫正视力（BSCVA）以及获取手术机会的差异。新西兰卫生部使用国家优先排序网络服务（NPWS）对所有公费白内障手术患者进行优先排序。此前尚未评估优先排序时的BSCVA、种族、人口统计学和地理差异。
一项回顾性队列研究。在2014年11月至2019年3月期间，识别出44403名独特患者的61095次优先排序事件。从NPWS中提取的白内障优先排序事件与从国家健康指数数据库中提取的出生日期和种族信息合并。所有数据在进行统计分析前均进行了去识别处理。
优先排序时的平均年龄为74.4岁，女性占多数（56%）。总体种族中，“欧洲人”占69.8%，“新西兰毛利人”占9.6%。平均Snellen BSCVA为6/30-2（优先排序眼），双眼为6/12-1。毛利人和太平洋岛民比其他种族平均早10年就诊，BSCVA明显更差。74.4%的优先排序事件获得了手术批准，平均Snellen BSCVA为6/38-2。在优先排序眼中，只有34.9%的新西兰患者Snellen BSCVA达到6/12或更好，而欧盟这一比例为58.4%。白内障SIR因地区而异。
新西兰的白内障SIR低于大多数经济合作与发展组织国家，患者在优先排序时的BSCVA明显更差。新西兰白内障手术的可及性因地区而异。毛利人和太平洋岛民就诊年龄更小，BSCVA更差，这表明在及时转诊和优先排序方面可能存在障碍。
