Abstract：
OBJECTIVE: Timing of surgical intervention in glaucoma is crucial to preserving sight. While ocular characteristics that increase surgical risk are known, the impact of neighborhood-level social risk factors such as the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI) on time to glaucoma surgery is unknown. The objective of this study was to evaluate the association between SVI or ADI scores and the timing of glaucoma surgical intervention.
METHODS: Retrospective cohort study.
METHODS: Adult subjects with open-angle glaucoma were identified from the Bascom Palmer Glaucoma Repository using International Classification of Disease-10 codes. Subject demographics, ocular characteristics, and standard automated perimetry data were extracted. Geocoded data were obtained using subject residences and American Community Survey data. Univariable and multivariable time-to-event survival analyses using accelerated failure time models were completed to evaluate whether geocoded SVI and ADI scores accelerated or delayed time to glaucoma surgery from initial glaucoma diagnosis in the electronic health record.
RESULTS: A total of 10,553 eyes from 6934 subjects were evaluated, of which 637 eyes (6.0%) from 568 subjects (8.2%) underwent glaucoma surgery. Mean age was 68.3 ± 13.5 years, with 57.9% female, 21.5% Black, and 34.5% Hispanic subjects. Mean follow-up time was 5.0 ± 2.1 years, with time to surgery of 3.2 ± 1.9 years. Multivariable accelerated failure time models demonstrated that higher mean intraocular pressure (time ratio [TR] 0.27 per 5 mm Hg higher; 95% confidence interval [CI]: 0.23-0.31, P < .001), faster standard automated perimetry rate of progression (TR 0.74 per 0.5 dB/year faster; 95% CI: 0.69-0.78, P < .001), moderate (TR 0.69; 95% CI: 0.56-0.85, P < .001) or severe baseline severity (TR 0.39; 95% CI: 0.32-0.47, P < .001), and thinner central corneal thickness (TR 0.85 per 50 µm thinner; 95% CI: 0.77-0.95, P = .003) all accelerated time to surgery. In contrast, overall SVI delayed surgery (TR 1.11 per 25% increase; 95% CI: 1.03-1.20, P = .006). Specifically, SVI Themes 1 (TR 1.08; 95% CI: 1.01-1.17, P = .037) and 4 (TR 1.11; 95% CI: 1.03-1.19, P = .006) were significant. Patients from the most deprived neighborhoods (highest national ADI quartile) had a 68% increase in time to surgery compared to the least deprived quartile (TR 1.68; 95% CI: 1.20-2.36, P = .002).
CONCLUSIONS: Residence in areas with higher SVI or ADI scores was associated with delayed glaucoma surgery after controlling for demographic and ocular parameters. Awareness of such disparities can guide initiatives aimed at achieving parity in health outcomes.
METHODS: Retrospective cohort study.
METHODS: Adult subjects with open-angle glaucoma were identified from the Bascom Palmer Glaucoma Repository using International Classification of Disease-10 codes. Subject demographics, ocular characteristics, and standard automated perimetry data were extracted. Geocoded data were obtained using subject residences and American Community Survey data. Univariable and multivariable time-to-event survival analyses using accelerated failure time models were completed to evaluate whether geocoded SVI and ADI scores accelerated or delayed time to glaucoma surgery from initial glaucoma diagnosis in the electronic health record.
RESULTS: A total of 10,553 eyes from 6934 subjects were evaluated, of which 637 eyes (6.0%) from 568 subjects (8.2%) underwent glaucoma surgery. Mean age was 68.3 ± 13.5 years, with 57.9% female, 21.5% Black, and 34.5% Hispanic subjects. Mean follow-up time was 5.0 ± 2.1 years, with time to surgery of 3.2 ± 1.9 years. Multivariable accelerated failure time models demonstrated that higher mean intraocular pressure (time ratio [TR] 0.27 per 5 mm Hg higher; 95% confidence interval [CI]: 0.23-0.31, P < .001), faster standard automated perimetry rate of progression (TR 0.74 per 0.5 dB/year faster; 95% CI: 0.69-0.78, P < .001), moderate (TR 0.69; 95% CI: 0.56-0.85, P < .001) or severe baseline severity (TR 0.39; 95% CI: 0.32-0.47, P < .001), and thinner central corneal thickness (TR 0.85 per 50 µm thinner; 95% CI: 0.77-0.95, P = .003) all accelerated time to surgery. In contrast, overall SVI delayed surgery (TR 1.11 per 25% increase; 95% CI: 1.03-1.20, P = .006). Specifically, SVI Themes 1 (TR 1.08; 95% CI: 1.01-1.17, P = .037) and 4 (TR 1.11; 95% CI: 1.03-1.19, P = .006) were significant. Patients from the most deprived neighborhoods (highest national ADI quartile) had a 68% increase in time to surgery compared to the least deprived quartile (TR 1.68; 95% CI: 1.20-2.36, P = .002).
CONCLUSIONS: Residence in areas with higher SVI or ADI scores was associated with delayed glaucoma surgery after controlling for demographic and ocular parameters. Awareness of such disparities can guide initiatives aimed at achieving parity in health outcomes.
摘要：
目的：青光眼手术干预的时机对保持视力至关重要。虽然增加手术风险的眼部特征是已知的，社区层面的社会危险因素如社会脆弱性指数(SVI)和区域剥夺指数(ADI)对青光眼手术时间的影响尚不清楚.这项研究的目的是评估SVI或ADI评分与青光眼手术干预时机之间的关系。
方法：回顾性队列研究。
方法：使用国际疾病分类-10代码从BascomPalmer青光眼资料库中鉴定出患有开角型青光眼的成年受试者。主题人口统计，眼部特征,并提取标准自动视野（SAP）数据。使用受试者住所和美国社区调查数据获得地理编码数据。使用加速失效时间（AFT）模型完成了单变量和多变量时间至事件生存分析，以评估在电子健康记录中从初始青光眼诊断到青光眼手术的地理编码SVI和ADI评分是否加速或延迟。
结果：共评估了6,934名受试者的10,553只眼，其中568例(8.2%)受试者中的637例(6.0%)眼接受了青光眼手术。平均年龄为68.3±13.5岁，57.9%为女性,21.5%黑色,和34.5%的西班牙裔受试者。平均随访时间为5.0±2.1年,手术时间为3.2±1.9年。多变量AFT模型显示较高的平均眼压（时间比（TR）每5mmHg高0.27；95％CI：0.23-0.31，p<0.001），更快的SAP进展率（TR0.74每0.5dB/年更快；95%CI：0.69-0.78，p<0.001），中度（TR0.69;95％CI：0.56-0.85，p<0.001）或重度基线严重程度（TR0.39;95％CI：0.32-0.47，p<0.001），和较薄的中央角膜厚度（每50µm厚度的TR0.85；95％CI：0.77-0.95，p=0.003）都加速了手术时间。相比之下,总体SVI延迟手术(TR1.11每增加25%;95%CI:1.03-1.20,p=0.006)。具体来说,SVI主题1(TR1.08;95%CI:1.01-1.17,p=0.037)和4(TR1.11;95%CI:1.03-1.19,p=0.006)显著。与最不被剥夺的四分位数相比，来自最贫困社区（全国ADI最高四分位数）的患者的手术时间增加了68％（TR1.68；95％CI：1.20-2.36，p=0.002）。
结论：在控制人口统计学和眼部参数后，SVI或ADI评分较高的地区居住与延迟性青光眼手术相关。对这种差异的认识可以指导旨在实现健康结果均等的举措。
方法：回顾性队列研究。
方法：使用国际疾病分类-10代码从BascomPalmer青光眼资料库中鉴定出患有开角型青光眼的成年受试者。主题人口统计，眼部特征,并提取标准自动视野（SAP）数据。使用受试者住所和美国社区调查数据获得地理编码数据。使用加速失效时间（AFT）模型完成了单变量和多变量时间至事件生存分析，以评估在电子健康记录中从初始青光眼诊断到青光眼手术的地理编码SVI和ADI评分是否加速或延迟。
结果：共评估了6,934名受试者的10,553只眼，其中568例(8.2%)受试者中的637例(6.0%)眼接受了青光眼手术。平均年龄为68.3±13.5岁，57.9%为女性,21.5%黑色,和34.5%的西班牙裔受试者。平均随访时间为5.0±2.1年,手术时间为3.2±1.9年。多变量AFT模型显示较高的平均眼压（时间比（TR）每5mmHg高0.27；95％CI：0.23-0.31，p<0.001），更快的SAP进展率（TR0.74每0.5dB/年更快；95%CI：0.69-0.78，p<0.001），中度（TR0.69;95％CI：0.56-0.85，p<0.001）或重度基线严重程度（TR0.39;95％CI：0.32-0.47，p<0.001），和较薄的中央角膜厚度（每50µm厚度的TR0.85；95％CI：0.77-0.95，p=0.003）都加速了手术时间。相比之下,总体SVI延迟手术(TR1.11每增加25%;95%CI:1.03-1.20,p=0.006)。具体来说,SVI主题1(TR1.08;95%CI:1.01-1.17,p=0.037)和4(TR1.11;95%CI:1.03-1.19,p=0.006)显著。与最不被剥夺的四分位数相比，来自最贫困社区（全国ADI最高四分位数）的患者的手术时间增加了68％（TR1.68；95％CI：1.20-2.36，p=0.002）。
结论：在控制人口统计学和眼部参数后，SVI或ADI评分较高的地区居住与延迟性青光眼手术相关。对这种差异的认识可以指导旨在实现健康结果均等的举措。
