Equal access, (Un)equal uptake: a longitudinal study of cataract surgery uptake in older people in England

Waiting Times for Cataract Surgery in Scotland since 2002 and the Effect of Austerity: An Interrupted Time Series Analysis

PURPOSE

In Scotland, in 2002, the National Waiting Times Unit was launched to reduce NHS waiting times. This was accompanied by a series of waiting time targets across the NHS in Scotland. The purpose of this study is to analyse changes in equality of access to treatment by socioeconomic deprivation associated with this initiative.

METHODS

Trends in annual cataract rates were calculated using secondary care admissions' Scottish Morbidity Record (SMR01) data on NHS funded elective cataract procedures for patients treated in Scotland from 01 April 1997 to 31 March 2019. An interrupted time series model was used to analyse socioeconomic differences in waiting times by deprivation quintile over three time periods; pre and post waiting time initiative, and post austerity.

RESULTS

Cataract Surgical Rates more than doubled from 3,723 per million population in 1997/1998 to 7,896 per million population in 2018/2019. Mean waiting time fell from 129.5 days in 1997/1998 to 87.7 days in 2018/2019. Inequality in mean waiting time between most and least deprived cataract patients increased by 1.34 days per quarter between 01 April 1997 and 30 June 2002 and following the waiting time initiative fell by 0.41 days per quarter through to 31 March 2010; and then decreased by 0.002 days per quarter between 01 April 2010 and 31 March 2019.

CONCLUSION

The waiting time initiative had a major impact on reducing inequality in waiting times between socioeconomic groups. The onset of austerity in 2010 was associated with a very small and insignificant increase in inequality.

Horizontal inequity in the utilization of cataract surgery in Iran: Shahroud Eye Cohort Study, 2009-2014

Background: Since there was no evidence about economic inequity in utilization of cataract surgery in developing countries, such as Iran, this study was designed to measure horizontal inequity in the utilization of cataract surgery and its changes in an Iranian middleaged population in 2009 and 2014. Methods: Using data from the first and second phases of Shahroud Eye Cohort Study (2009-2014), the economic inequity in the utilization of cataract surgery in an Iranian middle-aged population aged 40-64 years in 2009 and 2014 was evaluated. The horizontal inequity index (HI) was determined using the indirect standardization method based on a nonlinear (probit) model and the concentration index (C) was decomposed into the contribution of each factor. The analyses were performed using STATA software version 12/SE, and significance level was set at less than 0.05. Results: The HI in the utilization of cataract surgery increased from 0.080 (95% CI: 0.011-0.098) in 2009 to 0.166 (95% CI: 0.0821- 0.228) in 2014. Decomposition of changes in the concentration index showed that among need and non-need variables, older age and economic status (being among the wealthiest 20%) were the greatest contributors, with shares of 67.5% and 57.5%%, respectively, which led to pro-rich inequity during the study periods. Conclusion: The present study demonstrated that utilization of cataract surgery did not have an equal distribution among economic quintiles, despite considering equal needs based on cataract severity. Results demonstrated that older age and economic status were the greatest contributors to HI increase in 2009 and 2014.

The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 4, equity of access to cataract surgery

OBJECTIVE

To determine whether socioeconomic status influenced the presenting visual acuity prior to first eye cataract surgery in the English National Health Service. Retrospective case series from The Royal College of Ophthalmologists' National Ophthalmology Database Audit. In total 154,223 patients undergoing first eye cataract surgery at 68 centres in England performed between 1st September 2015 and 31st August 2017.

MAIN OUTCOME MEASURE

Social deprivation status and pre-operative visual acuity (VA) between centres for patients undergoing first eye cataract surgery in England.

RESULTS

The median social deprivation varied between centres and ranged from decile 2 (2nd most deprived decile) to decile 9 (2nd least deprived decile). The pre-operative VA was reported for 143,401 (93.0%) eyes. The median pre-operative VA was 0.50 LogMAR (6/19), and 27.7% eyes had a preoperative VA of 0.30 LogMAR units (6/12) or better. The median pre-operative VA for each centre ranged from 0.30 to 0.60 LogMAR (6/12 to 6/24). The median pre-operative VA was mostly stable across deciles of social deprivation (0.60 LogMAR for decile 1 and 0.50 LogMAR for all other deciles), and some evidence was found linking greater deprivation to worse pre-operative VA and to lower levels of access.

CONCLUSIONS

We found no strong evidence of inequality for gaining access to first eye cataract surgery in this National Ophthalmology Database analysis, however there was a possible trend towards fewer people in the more deprived deciles accessing surgery, and that some of these are presenting with quite marked levels of visual impairment.