评估在一家三级转诊中心的圆锥角膜和交联手术的健康差异和获取障碍。

Assessment of Health Disparities and Barriers to Accessing Keratoconus and Crosslinking at a Tertiary Referral Center.

机构信息

University of Auckland, Auckland, New Zealand; and.

Greenlane Clinical Centre, Auckland, New Zealand.

出版信息

Cornea. 2024 Mar 1;43(3):277-284. doi: 10.1097/ICO.0000000000003293. Epub 2023 Apr 24.

DOI:10.1097/ICO.0000000000003293

Abstract

PURPOSE

The aim of this study was to determine the barriers to accessing the crosslinking service in Auckland, New Zealand.

METHODS

This was a prospective 1-year study of patients at Auckland District Health Board. Studied parameters included age, sex, body mass index, ethnicity, New Zealand Deprivation (NZDep; an area-based measure of socioeconomic status, 1 = low deprivation-10 = high deprivation) score of residence, disease severity (maximum keratometry and thinnest corneal thickness), attendance, distance travelled, car ownership, employment status, and visual outcomes. Statistical analysis was performed using independent t tests, Pearson correlation, independent samples ANOVA, MANCOVA, and binomial logistic regression.

RESULTS

Four hundred fifty-four patients with keratoconus were analyzed and had a mean age of 24.1 ± 0.8 years, mean body mass index of 33.0 ± 9.7 kg/m 2 , and 43% were female. Pacific Peoples consisted 40.2% of the population; Māori 27.2%; Europeans 21.2%; Asian 9.9%; and Middle Eastern, Latin American, and African (MELAA) 1.3%. The mean distance travelled was 12.5 ± 9.5 km, NZDep score was 6.8 ± 2.6, and attendance was 69.0 ± 42.5%. The lowest attendance was observed in Pacific Peoples (58.9%) and the highest was in Asians (90%) ( P = 0.019). The mean worst-eye visual acuity at attendance was 0.75 ± 0.47 logMAR (6/35). Unemployment was associated with worse best-eye visual acuity at FSA ( P = 0.01) and follow-up ( P < 0.05). Māori and Pacific Peoples had the highest NZDep ( P < 0.001), were younger at presentation ( P = 0.019), had higher disease severity ( P < 0.001), and worse visual acuity ( P < 0.001).

CONCLUSIONS

Poor attendance was seen in this cohort. Pacific Peoples and Māori presented younger with worse disease severity and visual acuity but also had the highest nonattendance. These results suggest that deprivation, factors associated with ethnicity, and unemployment are potential barriers to attendance.

摘要

目的

本研究旨在确定在新西兰奥克兰获取交联服务的障碍。

方法

这是一项针对奥克兰地区卫生局患者的前瞻性为期 1 年的研究。研究参数包括年龄、性别、体重指数、种族、新西兰贫困（NZDep；一种基于区域的社会经济地位衡量标准，1=低贫困-10=高贫困）得分、居住地点、疾病严重程度（最大角膜曲率和最薄角膜厚度）、就诊率、旅行距离、汽车拥有情况、就业状况和视力结果。使用独立 t 检验、皮尔逊相关、独立样本方差分析、MANCOVA 和二项逻辑回归进行统计分析。

结果

对 454 名圆锥角膜患者进行了分析，他们的平均年龄为 24.1±0.8 岁，平均体重指数为 33.0±9.7kg/m 2 ，其中 43%为女性。太平洋岛民占总人口的 40.2%；毛利人占 27.2%；欧洲人占 21.2%；亚洲人占 9.9%；中东、拉丁美洲和非洲人（MELAA）占 1.3%。平均旅行距离为 12.5±9.5km，NZDep 评分为 6.8±2.6，就诊率为 69.0±42.5%。就诊率最低的是太平洋岛民（58.9%），最高的是亚洲人（90%）（P=0.019）。就诊时最差眼视力平均为 0.75±0.47logMAR（6/35）。在 FSA（P=0.01）和随访时（P<0.05），失业与最佳眼视力较差相关。毛利人和太平洋岛民的 NZDep 评分最高（P<0.001），就诊时年龄更小（P=0.019），疾病严重程度更高（P<0.001），视力更差（P<0.001）。