Diverse Levels of Access to Cataract Surgery

Cataract surgery rates in the United States are higher among patients aged 70–79 years, males, and those with Hispanic ethnicity and lower among non-Hispanic Black patients, according to a nationally representative cohort study. Self-employed, out-of-work, and retired patients are also more likely to receive cataract surgery than those working for wages.

The findings suggest persistent disparities in who receives cataract surgery in the US, especially regarding race and ethnicity, and indicate a need for interventions to address health disparities and promote equal access to cataract surgery, said Ms Karen Fernandez.

Diverse cohort

One challenge with examining healthcare access disparities is ethnic and racial minorities are often underrepresented in academic studies, Fernandez noted. The patients and data for this study were drawn from the ‘All of Us’ research programme run by the US National Institutes of Health. The programme tracks medical information for a large and diverse national cohort, of whom nearly half are racial and ethnic minorities. Information collected includes self-reported health surveys, electronic health records, and some genomic data.

The current study examined factors associated with undergoing cataract surgery in more than 37,000 patients in the ‘All of Us’ cohort diagnosed with at least one cataract, of whom about 20% received at least one cataract surgery. Factors examined included age, race, and sex at birth, as well as social factors, including employment, education, income, and relationship status. The study also looked at cataract surgery rates for the entire cohort of more than 400,000 patients.

Significant disparities seen

The study found an overall rate of cataract surgery among patients with cataract diagnoses of 30.6 per 1,000 person-years of follow-up, Fernandez reported. The rate was higher for persons aged 70–79 at 58.5, Hispanics at 39.0, and males at 31.8. Amongst all race and ethnicity categories, non-Hispanic Black patients had the lowest rate at 24.4. The cataract surgery rate for the entire patient cohort, including those without cataract diagnoses, was 6.5.

In a multivariable Cox model, compared with rates for non-Hispanic White cataract patients, Hispanic cataract patients had an increased hazard of undergoing cataract surgery with a ratio of 1.31, and non-Hispanic Black patients had a lower hazard ratio of 0.88. Females had a decreased hazard ratio (0.94) compared with males. Male patients were also found to have more rapid progression to cataract surgery, and non-Hispanic Black patients a slower progression. Hispanics had shorter times to cataract surgery than other groups.

Compared with patients employed for wages, self-employed cataract patients had a higher hazard of cataract surgery at a ratio of 1.13, as did out-of-work patients at 1.12 and retired patients at 1.24. No significant differences were observed in cataract surgery rates by education, income, insurance, or relationship status, Fernandez reported.

“Overall, we saw a significant association among cataract surgery rates by sex at birth, age, and race and ethnicity,” Fernandez said. Time from diagnosis to cataract surgery was also significantly associated with all these factors. Though the researchers did not investigate reasons for these disparities, she added they hypothesised local barriers to access, transportation issues, and language, trust, and miscommunication issues may help explain the differences.

Ms Fernandez reported at ARVO 2024 in Seattle, US.

Karen Fernandez is a second-year medical student at Stanford University School of Medicine, Stanford, California, US. karenf6@stanford.edu