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Ong SS, Tran D, Westlund E, Ahmed I, Russell GB, Gonzales A, Handa JT, Cai CX. Neighborhood-Level Social Determinants of Health and Presenting Characteristics for Rhegmatogenous Retinal Detachments. JAMA Ophthalmol 2024:2822171. [PMID: 39115836 PMCID: PMC11310845 DOI: 10.1001/jamaophthalmol.2024.2889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/03/2024] [Indexed: 08/11/2024]
Abstract
Importance Functional outcomes after repair of rhegmatogenous retinal detachments (RRDs) are highly dependent on baseline visual acuity and foveal status. Adverse social determinants of health (SDOH) can present barriers to timely presentation for repair and limit vision outcomes. Objective To evaluate the association between neighborhood-level SDOH with baseline severity (visual acuity and fovea status) of RRD. Design, Setting, and Participants This was a retrospective cohort study that included adult patients 18 years and older who underwent primary repair of uncomplicated RRD at the Wilmer Eye Institute from January 2008 to December 2018. Study data were analyzed from December 2023 to April 2024. Exposures The census block group of patient home addresses were matched to multiple neighborhood-level SDOH including the Area Deprivation Index (ADI), per capita income, percentage of renters, percentage of rent burden, percentage of people using a food assistance program, percentage of uninsured individuals, mode of transportation to work, distance to the nearest transit stop, total road density, National Walkability Index, Index of Medical Underservice score, and aggregate cost of medical care. Main Outcomes and Measures Odds of presenting with vision worse than 20/40 or fovea-involving RRD using multivariable logistic regression adjusting for age, sex, race and ethnicity, and insurance. Results A total of 700 patients (mean [SD] age, 57.9 [12.4] years; 432 male [61.7%]) were included. Every decile increase in ADI, indicating more socioeconomic disadvantage, was associated with an increased odds of presenting with worse visual acuity and fovea-involving RRD (odds ratio [OR], 1.14; 95% CI, 1.04-1.24; P = .004 and OR, 1.13; 95% CI, 1.04-1.22; P = .005, respectively). Each $1000 increase in per capita income was associated with lower odds of presenting with worse vision (OR, 0.99; 95% CI, 0.98-0.99; P = .001). Every 1% increase in percentage of workers who drove to work was associated with an increased odds of presenting with worse vision and fovea-involving RRD (OR, 1.02; 95% CI, 1.01-1.03; P = .005 and OR, 1.01; 95% CI, 1.00-1.03; P = .04, respectively). Conclusions and Relevance Results of this cohort study suggest that patients with a residence in neighborhoods with more socioeconomic deprivation or a higher percentage of workers who drove to work were more likely to present with more severe RRD even after accounting for multiple individual-level characteristics. These findings support consideration of public policy changes to address the barriers faced by patients residing in certain neighborhoods who seek prompt surgical intervention for RRD to reduce health disparities in RRD outcomes.
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Affiliation(s)
- Sally S. Ong
- Department of Ophthalmology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Diep Tran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Erik Westlund
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ishrat Ahmed
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Gregory B. Russell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anthony Gonzales
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - James T. Handa
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cindy X. Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Ali M, Khan MJ, Dun C, Justin G, Makary MA, Woreta FA. Open Globe Injury Repairs Among Medicare Beneficiaries from 2011 to 2020. Ophthalmic Epidemiol 2024:1-7. [PMID: 39083566 DOI: 10.1080/09286586.2024.2371458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/19/2024] [Accepted: 06/18/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE To explore patient and surgeon characteristics for open globe injury repairs (OGRs) and rates of subsequent operations. METHODS Using a retrospective cohort design, eyes of patients ≥18 years who underwent OGR among 100% Medicare Fee-For-Service dataset from 2011 to 2020 were included. Current Procedural Terminology (CPT®) codes were used to identify OGR. Patient characteristics were reported, and surgeon characteristics were stratified by sex and compared using Chi-square and Student's t-test. Overall rate of subsequent operations was reported, and trends of subsequent operations over time were assessed using Cochrane-Armitage trend test. RESULTS A total of 16,576 patients with a mean age of 73.89 years (±12.89) underwent OGR. Most patients were White (79.68%, n = 13,207) and 49.44% (n = 8196) were female. More patients resided in a rural area (18.71%; n = 3102) relative to surgeon location (4.51%, n = 748; p < 0.001). A total of 5,898 surgeons performed these OGRs with 77.33% (n = 4,561) male and 22.67% (n = 1,337) female surgeons. Male surgeons performed most of the OGRs (76.35%, n = 12,655; p < 0.001). On average, a surgeon performed a single OGR annually (Mean: 1.08 ± 1.04; Range: 0.11-40). Among all OGRs, 51% (8,452/16,576) had ≥1 subsequent operations in median 29 days (IQR: 10-86), which increased during the last decade from 47% to 51% (p = 0.008). CONCLUSION Geographic and workforce disparities in ocular trauma warrant future investigation. Further studies can also assess the reasons for increase in the incidence of subsequent procedures after OGR over time.
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Affiliation(s)
- Muhammad Ali
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Muhammad Jehanzeb Khan
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Grant Justin
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Martin A Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fasika A Woreta
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Awidi AA, Woreta FA, Sabit A, Hu H, Potu N, Devience E, Wang J, Vupputuri S. The Effect of Racial/Ethnic and Socioeconomic Differences on Visual Impairment Prior to Cataract Surgery. Ophthalmology 2024:S0161-6420(24)00432-9. [PMID: 39033857 DOI: 10.1016/j.ophtha.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/01/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024] Open
Abstract
PURPOSE To compare the associations of race/ethnicity and socioeconomic status (SES) with visual impairment (VI) prior to surgical removal of cataracts across two large health systems in the U.S. Mid-Atlantic region. DESIGN Multi-institutional cross-sectional data study. PARTICIPANTS Patients aged 65 and older who underwent cataract surgery at Johns Hopkins Hospital (JHH) and Kaiser Permanente (KP) between January 1, 2017 and December 31, 2019. METHODS Covariates included patient age, sex, smoking status, surgery laterality, Charlson Comorbidity Index (CCI), and ocular comorbidities. Multivariable generalized estimating equation models were used to examine the association of race/ethnicity and area deprivation index (ADI) with visual acuity. MAIN OUTCOME MEASURES Visual acuity prior to cataract surgery was assessed using Log of Minimum Angle of Resolution (logMAR). Race/ethnicity and ADI were the main exposures of interest. RESULTS At JHH, 11,509 patients (17,731 eyes) were included, while KP had 7,143 patients (10,542 eyes). After adjusting for covariates, Black (β, 0.49), Asian (β, 0.83), and Hispanic patients (β, 0.95) were more likely to have worse visual acuity secondary to cataracts at JHH (P < 0.001 for all) compared to White patients. Similarly, at KP, Black (β, 0.56), Asian (β, 0.70), and Hispanic patients (β, 0.89) were more likely to have worse visual acuity (P < 0.001 for all) compared to White patients. Compared to those living in the least disadvantaged neighborhoods (Quartile [Q]1 ADI) at JHH, higher ADI quartiles (more deprived) were more likely to have worse visual acuity (β, 0.27; P = 0.001 for Q2, β, 0.40; P = 0.001 for Q3, β, 0.95; P < 0.001 for Q4). There was no significant association found between ADI and VI secondary to cataracts at KP. CONCLUSIONS Among older adults, non-White race/ethnicity was independently associated with VI secondary to cataracts in two large health systems in the U.S. Mid-Atlantic region, after adjustment for ADI. Area deprivation was also associated with VI but only in the JHH system. Our study suggests that non-White patients and those with lower SES are at greater risk of VI secondary to cataracts possibly due to social, structural and institutional barriers.
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Affiliation(s)
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, Maryland.
| | - Ahmed Sabit
- Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland
| | - Haihong Hu
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - Niteesh Potu
- Department of Neurology and Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Eva Devience
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins University, Baltimore, Maryland
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
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Tang T, Tran D, Han D, Zeger SL, Crews DC, Cai CX. Place, Race, and Lapses in Diabetic Retinopathy Care. JAMA Ophthalmol 2024; 142:581-583. [PMID: 38662344 PMCID: PMC11046402 DOI: 10.1001/jamaophthalmol.2024.0974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/24/2024] [Indexed: 04/26/2024]
Abstract
This cohort study investigates the association of neighborhood-level social determinants of health with lapses in diabetic retinopathy care by race and ethnicity.
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Affiliation(s)
- Tina Tang
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Diep Tran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Dingfen Han
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Scott L. Zeger
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Deidra C. Crews
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cindy X. Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Hussain ZS, Andoh JE, Loya A, Yousefi S, Boland MV. Impact of the Coronavirus Disease 2019 Pandemic on Surgical Volumes Among Fellowship-Trained Glaucoma Subspecialists. J Glaucoma 2024; 33:35-39. [PMID: 37523625 PMCID: PMC10796841 DOI: 10.1097/ijg.0000000000002269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/18/2023] [Indexed: 08/02/2023]
Abstract
PRCIS The change in glaucoma surgical volumes due to the coronavirus disease 2019 pandemic was not uniform across procedure types and was unequal between rural and urban practice locations. PURPOSE To quantify the impact of the coronavirus disease 2019 pandemic on surgical volumes performed by fellowship-trained glaucoma subspecialists. MATERIALS AND METHODS This retrospective cohort analysis of the Centers for Medicare and Medicaid Services Medicare Public Use File extracted all glaucoma surgeries, including microinvasive glaucoma surgeries (MIGSs), trabeculectomy, goniotomy, lasers, and cataract surgery, performed by fellowship-trained glaucoma surgeons in rural and urban areas between 2016 and 2020. Predicted estimates of 2020 surgical volumes were created utilizing linear squares regression. Percentage change between predicted and observed 2020 surgical volume estimates was analyzed. Statistical significance was achieved at P <0.05. RESULTS In 2020, fellowship-trained glaucoma surgeons operated mostly in urban areas (N = 810, 95%). A 29% and 31% decrease in predicted cataract surgery volumes in urban and rural areas, respectively, was observed. Glaucoma surgeries experienced a 36% decrease from predicted estimates (N = 56,781). MIGS experienced an 86% and 75% decrease in rural and urban areas, respectively. Trabeculectomy in rural areas experienced a 16% increase relative to predicted estimates while urban areas experienced a decrease of 3% ( P > 0.05). The number of goniotomies decreased by 10% more in rural areas than in urban areas (-22% and -12%, respectively). Laser procedures decreased by 8% more in urban areas than in rural areas (-18% and -10%, respectively). CONCLUSIONS Among glaucoma-trained surgeons, glaucoma surgeries experienced a greater volume loss than cataract surgeries. In urban US areas, relative reductions in MIGS and goniotomy volumes in urban areas may have been compensated by greater laser and trabeculectomy volumes. Trabeculectomies in rural areas were the only group exceeding predicted estimates. Glaucoma subspecialists may utilize these findings when planning for future events and in overcoming any remaining unmet need in terms of glaucoma care.
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Affiliation(s)
- Zain S. Hussain
- Dean McGee Eye Institute, Oklahoma City, OK, USA
- University of Medicine and Health Sciences, Basseterre, Saint Kitts and Nevis
| | - Joana E. Andoh
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Asad Loya
- Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
| | - Siamak Yousefi
- Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
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Ali M, Menard M, Zafar S, Williams BK, Knight OJ, Woreta FA. Sex and Racial and Ethnic Diversity Among Ophthalmology Subspecialty Fellowship Applicants. JAMA Ophthalmol 2023; 141:948-954. [PMID: 37651110 PMCID: PMC10472264 DOI: 10.1001/jamaophthalmol.2023.3853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/06/2023] [Indexed: 09/01/2023]
Abstract
Importance Physician-patient concordance in sex and race is associated with improved patient outcomes. Studies have explored diversity among ophthalmology residents and faculty, but to our knowledge, not among ophthalmology fellows. Objective To assess diversity by sex and race and ethnicity among fellowship applicants in ophthalmology subspecialties and compare match rates by applicants' sex and underrepresented in medicine (URiM) status. Design, Setting, and Participants This cohort study examined ophthalmology subspecialty fellowship data from the 2021 San Francisco Match. Main Outcomes and Measures Applicant characteristics were stratified by sex and URiM status and compared using χ2, Mann-Whitney U, and median tests. For applicants who matched, the percentages of female and URiM applicants were compared among the ophthalmic subspecialties. A multivariable logistic regression model was used to assess the association of applicant characteristics with their match outcomes. Results Included in the sample were 537 candidates who applied for an ophthalmology fellowship using the 2021 San Francisco Match; 224 applicants (42.6%) were female, and 60 applicants (12.9%) had URiM status. Females and males had similar match rates (70.5% [n = 158] and 69.2% [n = 209], respectively; P = .74), but females had a higher median (IQR) US Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) score (248 [240-258] vs 245 [234-254]; P = .01). The pediatric ophthalmology subspecialty had the highest percentage of female matched applicants (67.5%; 27 of 40 matched applicants), while the retina subspecialty had the highest percentage of males (68.9%; 84 of 122 matched applicants). URiM applicants had lower match rates (55.0%, n = 33) than non-URiM applicants (72.2%, n = 293; P = .007). The URiM applicants had lower median (IQR) scores on the USMLE Step 1 (238 [227-247]) compared with Asian applicants (246 [235-254]) and White applicants (243 [231-252]; P = .04). Additionally, URIM applicants submitted fewer median (IQR) applications (10 [1-23]) than Asian (21 [8-37]) and White (17 [8-32]; P = .001) applicants and completed fewer interviews (median [IQR], 2 [0-11]) than Asian (median [IQR], 12 [3-18]) and White applicants (median [IQR], 8 [1-14]; P = .001). Among matched fellows in each subspecialty, URiM applicants comprised 13.9% (n = 11) in glaucoma, 10% (n = 4) in pediatric ophthalmology, 7.3% (n = 6) in cornea, and 6.6% (n = 8) in retina. Conclusions and Relevance Ophthalmology subspecialty fellowship match rates were lower for URiM vs non-URiM applicants in 2021. Underrepresentation of females exists in the retina subspecialty, while racial and ethnic differences exist in all ophthalmology subspecialty fellowships examined. Monitoring trends in fellowship diversity over time should help inform where targeted efforts could improve diversity.
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Affiliation(s)
- Muhammad Ali
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Maylander Menard
- School of Medicine, Meharry Medical College, Nashville, Tennessee
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Basil K Williams
- Cincinnati Eye Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - O'Rese J Knight
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
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Werner L. Gender disparities in cataract and refractive surgery. J Cataract Refract Surg 2023; 49:449-450. [PMID: 37088933 DOI: 10.1097/j.jcrs.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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