Johns Hopkins School of Medicine, Baltimore, MD.
Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD.
Cornea. 2024 Jan 1;43(1):31-37. doi: 10.1097/ICO.0000000000003302. Epub 2023 Jun 9.
This study aimed to investigate racial disparities in the severity of keratoconus (KCN) at presentation, their intersection with socioeconomic variables, and other factors associated with visual impairment.
This retrospective cohort study examined medical records of 1989 patients (3978 treatment-naive eyes) with a diagnosis of KCN seen at Wilmer Eye Institute between 2013 and 2020. A multivariable regression model adjusting for age, sex, race, insurance type, KCN family history, atopy, smoking status, and vision correction method examined factors associated with visual impairment, defined as a best available visual acuity of worse than 20/40 in the better eye.
Demographically, Asian patients were the youngest (33.4 ± 14.0 years) ( P < 0.001), and Black patients had the highest median area deprivation index (ADI) of 37.0 [interquartile range (IQR): 21.0-60.5] ( P < 0.001). Multivariable analysis showed a higher risk of visual impairment for Black (OR 2.25, 95% CI, 1.71-2.95) versus White patients. Medicaid (OR 2.59, 95% CI, 1.75-3.83) and Medicare (OR 2.48, 95% CI, 1.51-4.07) were also associated with a higher odds of visual impairment compared with private insurance, and active smokers were more likely to have visual impairment than those with no prior smoking history (OR 2.17, 95% CI, 1.42-3.30). Eyes of Black patients had the highest maximum keratometry (Kmax) (56.0 ± 11.0D) ( P = 0.003) and the lowest thinnest pachymetry (463.2 ± 62.5 µm) ( P = 0.006) compared with eyes of other races.
Black race, government-funded insurance, and active smoking were significantly associated with increased odds of visual impairment in adjusted analyses. Black race was also associated with higher Kmax and lower thinnest pachymetry, suggesting that Black patients have more severe disease at presentation.
本研究旨在探讨初诊时圆锥角膜（KCN）严重程度的种族差异，以及其与社会经济变量的交叉情况，和其他与视力损害相关的因素。
本回顾性队列研究共纳入了 2013 年至 2020 年期间在威尔默眼科研究所就诊的 1989 名（3978 只未经治疗的眼睛）KCN 患者的病历资料。采用多变量回归模型，调整了年龄、性别、种族、保险类型、KCN 家族史、特应性、吸烟状况和视力矫正方法等因素，以评估与视力损害相关的因素，定义为最佳矫正视力（BCVA）差于健眼的 20/40。
在人口统计学方面，亚洲患者最年轻（33.4 ± 14.0 岁）（P < 0.001），而黑人患者的区域剥夺指数（ADI）中位数最高（37.0 [四分位距（IQR）：21.0-60.5]）（P < 0.001）。多变量分析显示，与白人患者相比，黑人患者（OR 2.25，95%CI，1.71-2.95）发生视力损害的风险更高。与私人保险相比，医疗补助（OR 2.59，95%CI，1.75-3.83）和医疗保险（OR 2.48，95%CI，1.51-4.07）也与更高的视力损害几率相关，且当前吸烟者与无既往吸烟史者相比，更有可能出现视力损害（OR 2.17，95%CI，1.42-3.30）。与其他种族的眼睛相比，黑人患者的最大角膜曲率（Kmax）（56.0 ± 11.0D）最高（P = 0.003），最薄角膜厚度（463.2 ± 62.5 µm）最低（P = 0.006）。
在调整分析中，黑人种族、政府资助的保险和当前吸烟与视力损害几率增加显著相关。黑人种族也与更高的 Kmax 和更低的最薄角膜厚度相关，提示黑人患者在初诊时疾病更严重。
