种族、民族、保险和人口密度与 IRIS® 注册研究中儿童斜视和斜视性弱视的关系。
Race, Ethnicity, Insurance, and Population Density Associations with Pediatric Strabismus and Strabismic Amblyopia in the IRIS® Registry.
机构信息
Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington.
Department of Ophthalmology, Southern California Permanente Medical Group, San Diego, California.
出版信息
Ophthalmology. 2023 Oct;130(10):1090-1098. doi: 10.1016/j.ophtha.2023.06.008. Epub 2023 Jun 17.
PURPOSE
To evaluate the associations of sociodemographic factors with pediatric strabismus diagnosis and outcomes.
DESIGN
Retrospective cohort study.
PARTICIPANTS
American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients with strabismus diagnosed before the age of 10 years.
METHODS
Multivariable regression models evaluated the associations of race and ethnicity, insurance, population density, and ophthalmologist ratio with age at strabismus diagnosis, diagnosis of amblyopia, residual amblyopia, and strabismus surgery. Survival analysis evaluated the same predictors of interest with the outcome of time to strabismus surgery.
MAIN OUTCOME MEASURES
Age at strabismus diagnosis, rate of amblyopia and residual amblyopia, and rate of and time to strabismus surgery.
RESULTS
The median age at diagnosis was 5 years (interquartile range, 3-7) for 106 723 children with esotropia (ET) and 54 454 children with exotropia (XT). Amblyopia diagnosis was more likely with Medicaid insurance than commercial insurance (odds ratio [OR], 1.05 for ET; 1.25 for XT; P < 0.01), as was residual amblyopia (OR, 1.70 for ET; 1.53 for XT; P < 0.01). For XT, Black children were more likely to develop residual amblyopia than White children (OR, 1.34; P < 0.01). Children with Medicaid were more likely to undergo surgery and did so sooner after diagnosis (hazard ratio [HR], 1.23 for ET; 1.21 for XT; P < 0.01) than those with commercial insurance. Compared with White children, Black, Hispanic, and Asian children were less likely to undergo ET surgery and received surgery later (all HRs < 0.87; P < 0.01), and Hispanic and Asian children were less likely to undergo XT surgery and received surgery later (all HRs < 0.85; P < 0.01). Increasing population density and clinician ratio were associated with lower HR for ET surgery (P < 0.01).
CONCLUSIONS
Children with strabismus covered by Medicaid insurance had increased odds of amblyopia and underwent strabismus surgery sooner after diagnosis compared with children covered by commercial insurance. After adjusting for insurance status, Black, Hispanic, and Asian children were less likely to receive strabismus surgery with a longer delay between diagnosis and surgery compared with White children.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的
评估社会人口因素与儿科斜视诊断和结局的关系。
设计
回顾性队列研究。
参与者
美国眼科学会眼科学信息系统（智能研究在视力）登记处（Intelligent Research in Sight）在 10 岁之前被诊断为斜视的患者。
方法
多变量回归模型评估种族和民族、保险、人口密度和眼科医生比例与斜视诊断年龄、弱视诊断、残余弱视和斜视手术的关系。生存分析评估了相同的预测因子与斜视手术时间的关系。
主要观察指标
斜视诊断年龄、弱视和残余弱视的发生率、斜视手术的发生率和时间。
结果
106723 例内斜视（ET）和 54454 例外斜视（XT）儿童的中位诊断年龄为 5 岁（四分位间距 3-7）。与商业保险相比，医疗补助保险更有可能诊断出弱视（优势比[OR]，ET 为 1.05；XT 为 1.25；P <0.01）和残余弱视（OR，ET 为 1.70；XT 为 1.53；P <0.01）。与白人儿童相比，黑人儿童更有可能出现残余弱视（OR，1.34；P <0.01）。与商业保险相比，接受医疗补助保险的儿童更有可能接受手术，并且在诊断后更早接受手术（危险比[HR]，ET 为 1.23；XT 为 1.21；P <0.01）。与白人儿童相比，黑人、西班牙裔和亚洲儿童接受 ET 手术的可能性较小，接受手术的时间也较晚（所有 HR<0.87；P <0.01），西班牙裔和亚洲儿童接受 XT 手术的可能性较小，接受手术的时间也较晚（所有 HR<0.85；P <0.01）。人口密度和临床医生比例的增加与 ET 手术的 HR 降低有关（P <0.01）。
结论
与接受商业保险的儿童相比，接受医疗补助保险的斜视儿童出现弱视的几率更高，并且在诊断后更早接受斜视手术。在调整保险状况后，与白人儿童相比，黑人、西班牙裔和亚洲儿童接受斜视手术的可能性较小，并且从诊断到手术的时间间隔较长。
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