Viterbi Family Department of Ophthalmology Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, University of California San Diego, La Jolla, CA.
UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA.
J Glaucoma. 2023 Sep 1;32(9):792-799. doi: 10.1097/IJG.0000000000002261. Epub 2023 Jul 18.
Racial/ethnic minorities are diagnosed with glaucoma at younger ages, and Blacks are more likely to be diagnosed with moderate-to-severe glaucoma. In addition, we highlight a gap in the use of diagnosis codes.
The purpose of this study was to analyze patterns of diagnosis coding usage and validate epidemiologic patterns of glaucoma onset and severity among primary glaucoma patients within the National Institutes of Health All of Us database.
We used International Classification of Disease diagnosis codes to build 4 cohorts of patients with mild, moderate, severe, and unspecified stage glaucoma (N=2982). Descriptive analyses were stratified by disease stage, and mean age at diagnosis was compared across racial and ethnic groups. Multivariable ordinal regression was used to examine risk factors for increasing glaucoma severity.
Of 2982 participants, 1714 (57%) had unspecified severity staging. Black/African Americans and other races were diagnosed with glaucoma at significantly younger ages compared with Whites (means 60 and 60 vs. 66 y; P <0.001). Hispanic/Latino participants also had an earlier mean age of diagnosis (61 vs. 65 y; P =0.001). Black/African Americans had higher odds of more severe glaucoma (odds ratio: 2.20, 95% CI, 1.62-3.30; P <0.001) than Whites when adjusting for socioeconomic characteristics.
Black, Hispanic/Latino, and other minority participants are diagnosed with glaucoma at younger ages, and Blacks are more likely to be diagnosed with moderate-to-severe glaucoma. These findings validate prior population-based studies. Furthermore, we observed a gap in the use of diagnosis codes, as only 43% of participants had a specified severity stage in this national cohort. This may have implications for large-scale observational research concerning glaucoma severity, as electronic health records and claims databases typically lack other measures of disease progression, such as imaging and visual field data.
少数族裔的青光眼诊断年龄较小，而黑种人更有可能被诊断为中重度青光眼。此外，我们还强调了诊断代码使用方面的差距。
本研究旨在分析美国国立卫生研究院“所有美国人”数据库中初级青光眼患者的诊断编码使用模式，并验证青光眼发病和严重程度的流行病学模式。
我们使用国际疾病分类诊断代码构建了 4 个轻度、中度、重度和未指定阶段青光眼患者队列（N=2982）。根据疾病阶段进行分层描述性分析，并比较不同种族和族裔群体的诊断年龄。采用多变量有序回归分析检查青光眼严重程度增加的危险因素。
在 2982 名参与者中，1714 名（57%）患有未指定严重程度分期。与白人相比，黑种人/非裔美国人和其他种族的青光眼诊断年龄明显较小（平均年龄分别为 60 岁和 60 岁与 66 岁；P<0.001）。西班牙裔/拉丁裔参与者的诊断年龄也较早（61 岁与 65 岁；P=0.001）。在调整社会经济特征后，黑种人/非裔美国人患更严重青光眼的几率高于白人（优势比：2.20，95%置信区间，1.62-3.30；P<0.001）。
黑种人、西班牙裔/拉丁裔和其他少数族裔参与者的青光眼诊断年龄较小，而黑种人更有可能被诊断为中重度青光眼。这些发现验证了先前的基于人群的研究。此外，我们观察到诊断代码使用方面存在差距，因为在这个全国性队列中，只有 43%的参与者有明确的严重程度分期。这可能对涉及青光眼严重程度的大规模观察性研究产生影响，因为电子健康记录和索赔数据库通常缺乏其他疾病进展的衡量标准，如影像学和视野数据。
