Cho Wendy K Tam, Hwang David G
Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
Departments of Political Science, Statistics, Mathematics, Computer Science, and Asian-American Studies, University of Illinois, Urbana-Champaign, Urbana, IL, USA.
J Racial Ethn Health Disparities. 2025 Apr;12(2):740-753. doi: 10.1007/s40615-024-01914-4. Epub 2024 Feb 8.
We examined whether cataract surgery utilization and preoperative visual acuity were associated with patient-specific factors, including ocular findings and comorbidities, general biomedical factors, and/or sociodemographic factors.
Retrospective, cross-sectional study.
SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: We reviewed the electronic health records of patients from 2012 to 2022 who were examined and followed for at least 2 years by an eye care provider at University of California San Francisco Health (UCSF Health) and who had cataract in at least one eye associated with best-corrected visual acuity of 20/25 or worse. Data include ocular factors (e.g., best-corrected visual acuity, lens opacity grade, diagnoses of glaucoma, and/or age-related macular degeneration), biomedical comorbidities, and sociodemographic factors including race/ethnicity, health insurance coverage, primary language spoken, and social vulnerability index.
Logistic and multivariate regression analyses.
We examined cataract surgery utilization and preoperative best-corrected visual acuity.
Compared to White and Asian patients, Black patients had the lowest rates of cataract surgery utilization and the poorest mean preoperative visual acuities, with Hispanic patients following in second place in both categories. However, when the analysis controlled for sociodemographic and biomedical factors, Medicaid insurance and speaking Chinese as a primary language emerged as significant associations. In addition, higher cataract surgery utilization rates were associated with worse preoperative best-corrected visual acuity, a concurrent diagnosis of glaucoma, and a concurrent diagnosis of macular degeneration. Worse preoperative visual acuity was associated with Spanish or Chinese language preference, Medicaid status, and glaucoma diagnosis; poorer preoperative visual acuity was only weakly correlated with increased social vulnerability.
After adjusting for other biomedical and sociodemographic variables, having Medicaid insurance and being a non-English speaker were the factors most notably associated with reduced cataract surgery utilization and poorer preoperative visual acuity. Health insurance and language barriers, as well as other biomedical and sociodemographic factors, may explain a large proportion of the racial disparities in both cataract surgery utilization and preoperative visual acuity observed among Black and Hispanic patients. Chinese-speaking patients with limited English proficiency are a vulnerable subgroup that exhibits lower rates of cataract surgery utilization and higher degrees of visual loss prior to undergoing cataract surgery compared to other Asian patients.
我们研究了白内障手术的利用率和术前视力是否与患者特定因素相关，这些因素包括眼部检查结果和合并症、一般生物医学因素和/或社会人口统计学因素。
回顾性横断面研究。
研究对象、参与者和/或对照：我们回顾了2012年至2022年期间在加州大学旧金山分校医疗中心（UCSF Health）接受眼科护理人员检查并随访至少2年、且至少一只眼睛患有白内障且最佳矫正视力为20/25或更差的患者的电子健康记录。数据包括眼部因素（如最佳矫正视力、晶状体混浊分级、青光眼诊断和/或年龄相关性黄斑变性）、生物医学合并症以及社会人口统计学因素，包括种族/族裔、医疗保险覆盖范围、主要语言和社会脆弱性指数。
逻辑回归和多变量回归分析。
我们研究了白内障手术的利用率和术前最佳矫正视力。
与白人和亚裔患者相比，黑人患者的白内障手术利用率最低，术前平均视力最差，西班牙裔患者在这两个方面均位居第二。然而，在对社会人口统计学和生物医学因素进行分析控制后，医疗补助保险和以中文作为主要语言成为显著相关因素。此外，白内障手术利用率较高与术前最佳矫正视力较差、同时诊断为青光眼以及同时诊断为黄斑变性有关。术前视力较差与偏好西班牙语或中文、医疗补助状态以及青光眼诊断有关；术前视力较差与社会脆弱性增加仅存在微弱关联。
在调整其他生物医学和社会人口统计学变量后，拥有医疗补助保险和非英语使用者是与白内障手术利用率降低和术前视力较差最显著相关的因素。医疗保险和语言障碍，以及其他生物医学和社会人口统计学因素，可能在很大程度上解释了黑人和西班牙裔患者在白内障手术利用率和术前视力方面观察到的种族差异。与其他亚裔患者相比，英语水平有限的华语患者是一个脆弱的亚组，其白内障手术利用率较低，在接受白内障手术前视力丧失程度较高。
