Maturi Jay, Maturi Vikas, Scott Adrienne W, Carson Kathryn A, Ciulla Thomas, Maturi Raj
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Retina Service, Midwest Eye Institute, Indianapolis, IN, USA.
J Vitreoretin Dis. 2024 Jan 4;8(3):270-279. doi: 10.1177/24741264231221607. eCollection 2024 May-Jun.
To examine disparities in visual acuity (VA) outcomes 1 year and 2 years after initiation of diabetic retinopathy (DR) or diabetic macular edema (DME) treatment in patients based on race/ethnicity and insurance status, accounting for disease severity. This retrospective analysis used the IRIS Registry and included DR patients older than 18 years with documented antivascular endothelial growth factor (anti-VEGF) treatment and VA data for at least 2 years. International Classification of Diseases, Tenth Revision, Clinical Modification codes were used to determine the severity of DR and DME presence. VA outcomes were assessed using multivariable linear regressions and anti-VEGF drug use by multivariable logistic regressions, with race and insurance status as independent variables. Main outcome measures comprised the mean VA change at 1 year and 2 years and percentage of patients treated with bevacizumab. The study included 43 274 eyes. White patients presented with a higher mean VA and lower mean DR severity than Black patients and Hispanic patients. Multivariable logistic regression showed Hispanic patients were significantly more likely to be treated with bevacizumab than White patients across all insurance types, controlling for disease severity and VA. After 1 year, the letter improvement was 1.73, 1.33, and 1.13 in White patients, Black patients, and Hispanic patients, respectively. Multivariable linear regression suggested that across races, Medicaid-insured patients had significantly smaller gains in VA than privately insured patients. Race-based and insurance-based differences in 1-year and 2-year outcomes after anti-VEGF treatment for DR and anti-VEGF treatment patterns suggest a need to ensure earlier and more effective treatment of minority and underserved patients in the United States.
为了研究基于种族/民族和保险状况的糖尿病视网膜病变（DR）或糖尿病性黄斑水肿（DME）患者在开始治疗1年和2年后视力（VA）结果的差异，并考虑疾病严重程度。这项回顾性分析使用了IRIS注册中心的数据，纳入了年龄超过18岁、有抗血管内皮生长因子（anti-VEGF）治疗记录且至少有2年VA数据的DR患者。使用国际疾病分类第十次修订本临床修订版代码来确定DR和DME的严重程度。通过多变量线性回归评估VA结果，通过多变量逻辑回归评估anti-VEGF药物的使用情况，将种族和保险状况作为自变量。主要结局指标包括1年和2年时的平均VA变化以及接受贝伐单抗治疗的患者百分比。该研究纳入了43274只眼睛。白人患者的平均VA较高，DR平均严重程度低于黑人患者和西班牙裔患者。多变量逻辑回归显示，在所有保险类型中，西班牙裔患者接受贝伐单抗治疗的可能性显著高于白人患者，同时控制了疾病严重程度和VA。1年后，白人患者、黑人患者和西班牙裔患者的视力改善分别为1.73、1.33和1.13。多变量线性回归表明，在所有种族中，参加医疗补助保险的患者VA改善幅度显著小于参加私人保险的患者。DR抗VEGF治疗后1年和2年的结果以及抗VEGF治疗模式在种族和保险方面的差异表明，有必要确保美国少数族裔和服务不足患者能够更早、更有效地接受治疗。
