Research indicates discrepancies in access to healthcare and prevalence of ophthalmologic conditions based on demographic characteristics, with the prevalence of primary ophthalmologic diseases differing by racial and ethnic subgroups, explains Chandru Rasendran, BSE. “Ophthalmic care is largely delivered in the outpatient setting, which makes it critical to analyze any potential disparities in the delivery of adequate care in this setting,” he says. “Such an analysis is especially important for disadvantaged populations, whose problems are more likely to be overlooked.” To better understand differences in ophthalmologic care based on demographic characteristics, Rasendran and colleagues conducted a retrospective, cross-sectional study, published in The American Journal of Ophthalmology.

Ophthalmic Care Demographics

To characterize relative utilization of ophthalmic care based on patient demographic characteristics like race, ethnicity, income, insurance type, geographical region, and educational attainment, the study team analyzed the Medical Expenditure Panel Survey (MEPS). Demographic data from MEPS, including household demographic, medical diagnoses, and event files with expenditure, were analyzed for trends. The researchers used a multivariable logistic regression model to determine the association between demographic and socioeconomic characteristics with utilization of outpatient ophthalmologic care from 2007 to 2015.

Disparities in Care

Results indicated that lower-income, minority, and less educated Americans were less likely to visit an outpatient ophthalmologist than higher-income, majority, and more educated Americans. Individuals with no degree (reference, bachelor’s degree or higher; adjusted odds ratio [aOR], 0.82), those with a high school diploma or equivalent (aOR, 0.69), and those with some college (aOR, 0.63) were all less likely to utilize an outpatient ophthalmologist than those with a bachelor’s degree or higher. Similarly, the likelihood of visiting an outpatient ophthalmologist increased along with household income. “These characteristics identify many disadvantaged individuals across the nation who would benefit from more regular ophthalmic care,” notes Rasendran. Geographic location was also found to be an indicator of the likelihood of visiting an outpatient ophthalmologist; the Northeast had the highest likelihood, while the South (reference, Northeast; aOR 0.75), Midwest (aOR 0.75), and West (aOR 0.75) were all less likely to visit an outpatient ophthalmologist.

Racial and ethnic disparities persisted in annual healthcare use among patients claiming ophthalmologic conditions (Table). Non-Hispanic white patients had higher rates of outpatient utilization and were less likely to visit the emergency room, while Hispanic patients (reference, non-Hispanic white; aOR, 0.72) and black patients (aOR, 0.74) were less likely to visit an outpatient ophthalmologist. “Non-Hispanic white patients had less average total expenditures in the emergency room setting but higher costs per visit, suggesting increased utilization of the emergency room for these patients in more emergent conditions when compared with minority patients,” adds Rasendran. “Additionally, minority Americans had more emergency room visits for ophthalmic conditions, suggesting that inadequate outpatient care may lead to increased emergency room utilization and costs for these patients.”

Increasingly Important

The study findings highlight the importance of healthcare access and deliverability both regionally and nationally, according to Rasendran. “I believe these findings help quantify the possible disproportional outpatient care utilized by disadvantaged populations,” he says. “I hope ophthalmologists utilize this data to better develop ophthalmic healthcare prediction models and future needs, especially with the changing demographics of the nation.”

Looking to the near future of ophthalmic care, Rasendran has some concerns. “The US population is projected to be majority minority by 2044, so disparities affecting minorities in ophthalmic care will continue to become increasingly important to identify and address,” he says. “This projection enhances the need for more research regarding healthcare delivery models for ophthalmic care and to better characterize the underlying etiologies behind these disparities in outpatient ophthalmic care seen in underserved patients.”

References

Demographic and Socioeconomic Differences in Outpatient Ophthalmology Utilization in the United States https://www.ajo.com/article/S0002-9394(20)30252-X/fulltext