Characteristics Associated With Receiving Cataract Surgery in the US Medicare and Veterans Health Administration Populations.
JAMA Ophthalmol
; 136(7): 738-745, 2018 07 01.
Article
em En
| MEDLINE
| ID: mdl-29800973
ABSTRACT
Importance Considerable variation exists with respect to the profiles of patients who receive cataract surgery in the United States. Objective:
To identify patient characteristics associated with receiving cataract surgery within the US Medicare and Veterans Health Administration (VHA) populations. Design, Setting, andParticipants:
In this population-based retrospective cohort study of 3 073 465 patients, Medicare and VHA patients with a cataract diagnosis between January 1, 2002, and January 1, 2012, were identified from the 2002-2012 Medicare Part B files (5% sample) and the VHA National Patient Care Database. Patient age, sex, race/ethnicity, region of residence, Charlson Comorbidity Index (CCI) scores, and comorbidities were recorded. Cataract surgery at 1 and 5 years after diagnosis was identified. Data analysis was performed from July 1, 2016, to July 1, 2017. Main Outcomes andMeasures:
Odds ratios (ORs) of cataract surgery for selected patient characteristics.Results:
The study sample included 1â¯156â¯211 Medicare patients (mean [SD] age, 73.7 [7.0] years) and 1â¯917â¯254 VHA patients (mean [SD] age, 66.8 [10.2] years) with a cataract diagnosis. Of the 1â¯156â¯211 Medicare patients, 407â¯103 (35.2%) were 65 to 69 years old, 683â¯036 (59.1%) were female, and 1â¯012â¯670 (87.6%) were white. Of the 1â¯917â¯254 VHA patients, 905â¯455 (47.2%) were younger than 65 years, 1â¯852â¯158 (96.6%) were male, and 539â¯569 (28.1%) were white. A greater proportion of Medicare patients underwent cataract surgery at 1 year (Medicare 213â¯589 [18.5%]; VHA 120â¯196 [6.3%]) and 5 years (Medicare 414â¯586 [35.9%]; VHA 240â¯884 [12.6%]) after diagnosis. Factors associated with the greatest odds of surgery at 5 years were older age per 5-year increase (Medicare OR, 1.24 [95% CI, 1.23-1.24]; VHA OR, 1.18 [95% CI, 1.17-1.18]), residence in the southern United States vs eastern United States (Medicare OR, 1.38 [95% CI, 1.36-1.40]; VHA OR, 1.40 [95% CI, 1.38-1.41]), and presence of chronic pulmonary disease (Medicare OR, 1.26 [95% CI, 1.24-1.27]; VHA OR, 1.40 [95% CI, 1.38-1.41]). Within Medicare, female sex was associated with greater odds of surgery at 5 years (OR, 1.14; 95% CI, 1.13-1.15). Higher CCI scores (CCI score ≥3 vs 0-2) were associated with increased odds of surgery among VHA but not Medicare patients at 5 years (Medicare OR, 0.94 [95% CI, 0.92-0.95]; VHA OR, 1.24 [95% CI, 1.23-1.36]). Black race vs white race was associated with decreased odds of cataract surgery 5 years after diagnosis (Medicare OR, 0.79 [95% CI, 0.78-0.81]; VHA OR, 0.75 [95% CI, 0.73-0.76]). Conclusions and Relevance Within both groups, older age, residence in the southern United States, and presence of chronic pulmonary disease were associated with increased odds of cataract surgery. Findings from this study suggest that few disparities exist between the types of patients receiving cataract surgery who are in Medicare vs the VHA, although it is possible that a smaller proportion of VHA patients receive surgery compared with Medicare patients.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Extração de Catarata
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Medicare Part B
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United States Department of Veterans Affairs
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Atenção à Saúde
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Acessibilidade aos Serviços de Saúde
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
JAMA Ophthalmol
Ano de publicação:
2018
Tipo de documento:
Article