目的:在美国中大西洋地区的两个大型卫生系统中,比较种族/民族和社会经济地位(SES)与白内障手术切除前视力障碍(VI)的关系。
方法:多机构横断面数据研究。
方法:2017年1月1日至2019年12月31日在约翰霍普金斯医院(JHH)和KaiserPermanente(KP)接受白内障手术的65岁及以上患者。
方法:协变量包括患者年龄,性别,吸烟状况,手术侧向性,Charlson合并症指数(CCI),和眼部合并症。多变量广义估计方程模型用于检查种族/民族和区域剥夺指数(ADI)与视力的关系。
方法:使用最小分辨角对数(logMAR)评估白内障手术前的视敏度。种族/民族和ADI是感兴趣的主要风险敞口。
结果:在JHH,11,509名患者(17,731只眼)被包括在内,而KP有7,143名患者(10,542只眼)。在调整协变量后,黑色(β,0.49),亚洲(β,0.83),和西班牙裔患者(β,0.95)与怀特患者相比,JHH时继发于白内障的视力更差(全部P<0.001)。同样,在KP,黑色(β,0.56),亚洲(β,0.70),和西班牙裔患者(β,与白人患者相比,0.89)的视力更有可能较差(全部P<0.001)。与生活在JHH的最弱势社区(Quartile[Q]1ADI)中的人相比,ADI四分位数越高(越剥夺)的视力越差(β,0.27;Q2,β,P=0.0010.40;Q3,β,P=0.0010.95;Q4P<0.001)。在KP时白内障继发的ADI和VI之间没有发现显着关联。
结论:在老年人中,在美国中大西洋地区的两个大型卫生系统中,非白人种族/民族与白内障继发VI独立相关,调整后的ADI。区域剥夺也与VI相关,但仅在JHH系统中。我们的研究表明,非白人患者和SES较低的患者患白内障继发VI的风险更大,结构和体制障碍。
OBJECTIVE: 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.
METHODS: Multi-institutional cross-sectional data study.
METHODS: 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.
METHODS: 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.