Disparities in delivery of ophthalmic care; An exploration of public Medicare data

Lee, Cecilia S.; Su, Grace L.; Baughman, Douglas M.; Wu, Yue; Lee, Aaron

doi:10.1371/journal.pone.0182598

Cited by 36 publications

(25 citation statements)

References 24 publications

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“…This result is in agreement with a previous report showing that the cataract surgical rate (CSR) was significantly associated with the gross domestic product per capital (GDP/P), with South Korea being one of the countries where CSR was below the economy‐projected rates . The relationship of socioeconomic factors and the residential area with cataract surgery has been reported . This was also observed in the present study, where most cataract surgeries were performed in cities (85.72% in metropolitan, large and small cities vs 14.28% in rural areas) and individuals with a higher household income (90%‐100% relative to the median).…”

Section: Discussionsupporting

confidence: 93%

Incidence and characteristics of cataract surgery in South Korea from 2011 to 2015: A nationwide population‐based study

Ryu

Kim

Hong

et al. 2020

Clinical Exper Ophthalmology

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Importance: Detailed incidence data for cataract surgery in the general population are limited, yet important for determining the surgical needs of the community and formulation of healthcare policies.Background: To report incidence rates of cataract surgery in South Korea.Design: Nationwide, retrospective population-based study. Participants: This study involved the entire population of South Korea (n = 47 990 761); 2 236 107 eyes of 1 591 176 patients confirmed as having cataract surgery from 1 January 2011 to 31 December 2015 were included.Methods: Data for all patients who underwent primary cataract surgery in South Korea were retrieved using Korean Electronic Data Interchange and Korean Standard Classification of Diseases-7 codes. Annual incidence rates were calculated and adjusted to the national population data for the corresponding year.Main Outcome Measures: The average incidence of cataract surgery during the 5-year study period was estimated using population data from the 2010 Korean census.Results: The incidence of cataract surgery increased from 8.54/1000 personyears in 2011 to 9.67/1000 person-years in 2015. The probability of second-eye surgery within 12 months after the first-eye surgery increased from 42.98% in 2011 to 48.01% in 2015. In total, 85.72% of surgeries were performed in nonrural areas: 43.18% in individuals with a higher household income and 76.65% in primary healthcare centres. The rate of vitrectomy for posterior capsular rupture was 0.72%. Conclusions and Relevance: The incidence of cataract surgery in South Korea is increasing over time. Our findings are expected to aid in the formulation of future healthcare policies concerning cataract surgery in South Korea. K E Y W O R D S cataract surgery, epidemiology, incidence Sun Young Ryu and Jiwon Kim contributed equally to this study.

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Section: Discussionsupporting

confidence: 93%

Incidence and characteristics of cataract surgery in South Korea from 2011 to 2015: A nationwide population‐based study

Ryu

Kim

Hong

et al. 2020

Clinical Exper Ophthalmology

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“…In the general Medicare population, longer travel distance to the nearest ophthalmologist is associated with a decreased likelihood of receiving cataract surgery. 31 In PD, reduced mobility may effectively prolong the time required to reach an ophthalmologist and thus impose a similar barrier to access. To explore eye care utilization patterns in PD, we calculated the frequency of eye examination by year and found that less than 60% of Medicare beneficiaries with PD had at least 1 eye exam, indicating that a large proportion of patients with PD does not meet American Academy of Ophthalmology guidelines for eye examinations.…”

Section: Discussionmentioning

confidence: 99%

Visual Impairment Is More Common in Parkinson’s Disease and Is a Risk Factor for Poor Health Outcomes

et al. 2020

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Background Visual impairment is associated with hip fracture, depression, anxiety, and dementia in the general population, and many causes of visual impairment are preventable or treatable with early detection. However, the prevalence, outcomes, and healthcare utilization patterns associated with visual impairment have not been examined in Parkinson’s disease (PD). Methods We performed a cross‐sectional analysis of all Medicare beneficiaries with complete data in 2014 and longitudinal analysis of beneficiaries with PD from 2010 to 2014. We used diagnosis and procedure codes to identify PD, visual impairment, eye exams, hip fracture, and neuropsychiatric disorders. We compared the prevalence of visual impairment using logistic regression and used Cox proportional hazards regression to examine visual impairment and incident hip fracture, depression, anxiety, dementia, and death. We also examined the frequency of eye exams in PD using repeated‐measures logistic regression. Results Among 26,209,997 Medicare beneficiaries in 2014, visual impairment was significantly more prevalent in PD (1.7%) than non‐PD (0.71%) (adjusted odds ratio, 1.60; 95% confidence interval [CI], 1.56–1.65). In a longitudinal cohort of 542,224 Medicare beneficiaries with PD, less than 60% had a yearly eye exam. Visual impairment associated with increased hazard of depression (hazard ratio [HR], 1.23; 95% CI, 1.14–1.32), anxiety (HR, 1.34; 95% CI, 1.24–1.43), dementia (HR, 1.28; 95% CI, 1.21–1.36), and death (HR, 1.49; 95% CI, 1.44–1.55). Conclusion Visual impairment is more common in PD than the general population and is associated with negative PD‐related outcomes. Understanding the mechanisms for these relationships is important for guiding future interventions to improve health outcomes in PD. © 2020 International Parkinson and Movement Disorder Society

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“…Residents of US with low densities of eye care professionals, for example, have reduced likelihood of vision service access, even among those with insurance [24]. Further, rural and remote residents face additional challenges due to longer travel distances to receive vision care [25].…”

Section: Introductionmentioning

confidence: 99%

Geographic availability to optometry services across Canada: mapping distribution, need and self-reported use

Shah

Milosavljevic

Bath

2020

BMC Health Serv Res

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Background: This research investigates the distribution of optometrists in Canada relative to population health needs and self-reported use of vision services. Methods: Optometrist locations were gathered from provincial regulatory bodies. Optometrist-to-population ratios (i.e. the number of providers per 10,000 people at the health region level) were then calculated. Utilization of vision care services was extracted from the Canadian Community Health Survey (CCHS) 2013-2014 question regarding self-reported contacts with optometrists or ophthalmologists. Data from the 2016 Statistics Canada census were used to create three population 'need' subgroups (65 years and over; low-income; and people aged 15 and over with less than a high school diploma). Cross-classification mapping compared optometrist distribution to selfreported use of vision care services in relation to need. Each variable was converted into three classes (i.e., low, moderate, and high) using a standard deviation (SD) classification scheme where ±0.5SD from the mean was considered as a cutoff. Three classes: low (< − 0.5SD), moderate (− 0.5 to 0.5SD), and high (> 0.5SD) were used for demonstrating distribution of each variable across health regions. Results: A total of 5959 optometrists across ten Canadian provinces were included in this analysis. The nationwide distribution of optometrists is variable across Canada; they are predominantly concentrated in urban areas. The national mean ratio of optometrists was 1.70 optometrists per 10,000 people (range = 0.13 to 2.92). Out of 109 health regions (HRs), 26 were classified as low ratios, 51 HRs were classified as moderate ratios, and 32 HRs were high ratios. Thirty-five HRs were classified as low utilization, 39 HRs were classified as moderate, and 32 HRs as high utilization. HRs with a low optometrist ratio relative to eye care utilization and a high proportion of key sociodemographic characteristics (e.g. older age, low income) are located throughout Canada and identified with maps indicating areas of likely greater need for optometry services. Conclusion: This research provides a nationwide overview of vision care provided by optometrists identifying gaps in geographic availability relative to "supply" and "need" factors. This examination of variation in accessibility to optometric services will be useful to inform workforce planning and policies.

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Disparities in delivery of ophthalmic care; An exploration of public Medicare data

Cited by 36 publications

References 24 publications

Incidence and characteristics of cataract surgery in South Korea from 2011 to 2015: A nationwide population‐based study

Incidence and characteristics of cataract surgery in South Korea from 2011 to 2015: A nationwide population‐based study

Visual Impairment Is More Common in Parkinson’s Disease and Is a Risk Factor for Poor Health Outcomes

Geographic availability to optometry services across Canada: mapping distribution, need and self-reported use

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