加利福尼亚州医疗保险人群中的社会脆弱性、青光眼患病率和青光眼手术发病率。
Social Vulnerability, Prevalence of Glaucoma, and Incidence of Glaucoma Surgery in the California Medicare Population.
机构信息
Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California.
Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
出版信息
Ophthalmol Glaucoma. 2023 Nov-Dec;6(6):616-625. doi: 10.1016/j.ogla.2023.05.005. Epub 2023 May 19.
PURPOSE
To examine associations of Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) scores with prevalence of glaucoma and incidence of glaucoma surgery in 2019 California Medicare beneficiaries.
DESIGN
Retrospective cross-sectional study.
PARTICIPANTS
2019 California Medicare beneficiaries ≥ 65 years old with part A and part B coverage.
METHODS
The exposure of interest was SVI score, which was assessed overall and by themes. Outcomes included prevalence of glaucoma in the study population and incidence of glaucoma surgery in beneficiaries with glaucoma. Logistic regression modeling was performed to assess associations between quartiles of each type of SVI score, prevalence of glaucoma, and incidence of glaucoma surgery, controlling for age, sex, race/ethnicity, Charlson Comorbidity Index score, pseudophakia, and age-related macular degeneration.
MAIN OUTCOME MEASURES
Prevalence of any glaucoma, primary open angle glaucoma (POAG), secondary open angle glaucoma (SOAG), and angle closure glaucoma in all beneficiaries. Incidence of any glaucoma surgery, trabeculectomy, tube shunt, minimally invasive glaucoma surgery (MIGS), and cyclophotocoagulation (CPC) in beneficiaries with glaucoma.
RESULTS
Of 5 725 245 beneficiaries in the total study population, there were 215 814 (3.8%) with any glaucoma, and of those with glaucoma, 10 135/215 814 (4.7%) underwent glaucoma surgery. In adjusted analyses for overall SVI score, where higher levels of SVI refer to higher levels of social vulnerability, there were decreased odds of any glaucoma (adjusted odds ratio [aOR] = 0.83; 95% confidence interval [CI] = 0.82, 0.84 for Q4 vs. Q1), POAG (aOR = 0.85; 95% CI = 0.84, 0.87 for Q4 vs. Q1), and SOAG (aOR = 0.59; 95% CI = 0.55, 0.63 for Q4 vs. Q1) in higher (Q4) vs. lower (Q1) SVI quartile. There were increased odds of any glaucoma surgery (aOR = 1.19; 95% CI = 1.12, 1.26 for Q4 vs. Q1), MIGS (aOR = 1.24; 95% CI = 1.15, 1.33 for Q4 vs. Q1), and CPC (aOR = 1.49; 95% CI = 1.29, 1.76 for Q4 vs. Q1) for higher (Q4) vs. lower (Q1) SVI quartile.
CONCLUSIONS
In the 2019 California Medicare population, there were variable associations between SVI score, prevalence of glaucoma, and incidence of glaucoma surgery. Further investigation is needed to understand the role of social, economic, and demographic factors in glaucoma care on the individual and structural levels.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的
研究疾病控制与预防中心/有毒物质和疾病登记处社会脆弱性指数（SVI）得分与 2019 年加利福尼亚州医疗保险受益人的青光眼患病率和青光眼手术发病率之间的关系。
设计
回顾性横断面研究。
参与者
2019 年加利福尼亚州医疗保险≥65 岁，有 A 部分和 B 部分覆盖的受益人群。
方法
感兴趣的暴露是 SVI 评分，通过总体和主题进行评估。结果包括研究人群中青光眼的患病率和青光眼受益人的青光眼手术发病率。使用逻辑回归模型评估每个 SVI 评分四分位数与青光眼患病率和青光眼手术发病率之间的关联，控制年龄、性别、种族/民族、Charlson 合并症指数评分、白内障和年龄相关性黄斑变性。
主要观察指标
所有受益人群中任何青光眼、原发性开角型青光眼（POAG）、继发性开角型青光眼（SOAG）和闭角型青光眼的患病率。青光眼受益人中任何青光眼手术、小梁切除术、管分流术、微创青光眼手术（MIGS）和睫状体光凝术（CPC）的发病率。
结果
在总研究人群的 5725245 名受益人中，有 215814 名（3.8%）患有任何青光眼，其中 10135/215814 名（4.7%）接受了青光眼手术。在调整了总体 SVI 评分的分析中，较高的 SVI 水平表示更高的社会脆弱性，任何青光眼（调整后的优势比[aOR] = 0.83；95%置信区间[CI] = 0.82，0.84，Q4 与 Q1 相比）、POAG（aOR = 0.85；95%CI = 0.84，0.87，Q4 与 Q1 相比）和 SOAG（aOR = 0.59；95%CI = 0.55，0.63，Q4 与 Q1 相比）的可能性降低。任何青光眼手术（aOR = 1.19；95%CI = 1.12，1.26，Q4 与 Q1 相比）、MIGS（aOR = 1.24；95%CI = 1.15，1.33，Q4 与 Q1 相比）和 CPC（aOR = 1.49；95%CI = 1.29，1.76，Q4 与 Q1 相比）的可能性增加。
结论
在 2019 年加利福尼亚州医疗保险人群中，SVI 评分、青光眼患病率和青光眼手术发病率之间存在不同的关联。需要进一步研究以了解社会、经济和人口因素在个体和结构层面上对青光眼护理的作用。
金融披露
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