目的:评估社会人口统计学因素与儿童斜视诊断和预后的关系。
方法:回顾性队列研究。
方法:美国眼科学会IRIS®注册(视力智能研究)患者在10岁之前诊断为斜视。
方法:多变量回归模型评估了种族和民族的关联,保险,斜视诊断时的人口密度和眼科医生与年龄的比率,弱视的诊断,残余弱视,斜视手术.生存分析评估了斜视手术时间的相同预测因素。
方法:斜视诊断年龄,弱视率和残余弱视,斜视手术的速度和时间。
结果:106,723例内斜视(ET)患儿和54,454例外斜视(XT)患儿诊断时的中位年龄为5岁(四分位距:3-7)。弱视诊断更可能与医疗补助保险比商业保险(优势比[OR]1.05ET;1.25XT;p<0.01),残余弱视(ET为1.70;XT为1.53;p<0.01)。对于XT,黑人儿童比白人儿童更容易发生残余弱视(OR1.34;p<0.01)。与有商业保险的儿童相比,有医疗补助的儿童更有可能接受手术,并且在诊断后更早接受手术(风险比[HR]:ET为1.23;XT为1.21;p<0.01)。与白人儿童相比,黑色,西班牙裔,亚裔儿童接受ET手术的可能性较小,手术时间较晚(所有HR<0.87;p<0.05),西班牙裔和亚裔儿童接受XT手术的可能性较小,接受手术的可能性较晚(所有HR<0.85;p<0.05)。人口密度和临床医生比率的增加与ET手术的几率和HR降低相关(p<0.01)。
结论:与商业保险所承保的儿童相比,医疗补助保险所承保的斜视儿童患弱视的几率增加,诊断后更快接受斜视手术。在调整保险状态后,黑色,西班牙裔,与白人儿童相比,亚洲儿童不太可能接受斜视手术,诊断和手术之间的延迟更长。
To evaluate the associations of sociodemographic factors with pediatric strabismus diagnosis and outcomes.
Retrospective cohort study.
American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients with strabismus diagnosed before the age of 10 years.
Multivariable regression models evaluated the associations of race and ethnicity, insurance, population density, and ophthalmologist ratio with age at strabismus diagnosis, diagnosis of amblyopia, residual amblyopia, and strabismus surgery. Survival analysis evaluated the same predictors of interest with the outcome of time to strabismus surgery.
Age at strabismus diagnosis, rate of amblyopia and residual amblyopia, and rate of and time to strabismus surgery.
The median age at diagnosis was 5 years (interquartile range, 3-7) for 106 723 children with esotropia (ET) and 54 454 children with exotropia (XT). Amblyopia diagnosis was more likely with Medicaid insurance than commercial insurance (odds ratio [OR], 1.05 for ET; 1.25 for XT; P < 0.01), as was residual amblyopia (OR, 1.70 for ET; 1.53 for XT; P < 0.01). For XT, Black children were more likely to develop residual amblyopia than White children (OR, 1.34; P < 0.01). Children with Medicaid were more likely to undergo surgery and did so sooner after diagnosis (hazard ratio [HR], 1.23 for ET; 1.21 for XT; P < 0.01) than those with commercial insurance. Compared with White children, Black, Hispanic, and Asian children were less likely to undergo ET surgery and received surgery later (all HRs < 0.87; P < 0.01), and Hispanic and Asian children were less likely to undergo XT surgery and received surgery later (all HRs < 0.85; P < 0.01). Increasing population density and clinician ratio were associated with lower HR for ET surgery (P < 0.01).
Children with strabismus covered by Medicaid insurance had increased odds of amblyopia and underwent strabismus surgery sooner after diagnosis compared with children covered by commercial insurance. After adjusting for insurance status, Black, Hispanic, and Asian children were less likely to receive strabismus surgery with a longer delay between diagnosis and surgery compared with White children.
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