Socioeconomic and Demographic Disparities in Keratoconus Treatment

Rohith Erukulla; Mohammad Soleimani; Maria Woodward; Niranjan Karnik; Charlotte Joslin; Timothy McMahon; Angelica Scanzera; Ellen Shorter; Hannah Yoon; Maria Cortina; Jose de la Cruz; Sandeep Jain; Hajirah N Saeed; Elmer Tu; Mark Rosenblatt; Ali Djalilian

doi:10.1016/j.ajo.2024.11.023

Socioeconomic and Demographic Disparities in Keratoconus Treatment

Am J Ophthalmol. 2024 Nov 30:271:424-435. doi: 10.1016/j.ajo.2024.11.023. Online ahead of print.

Authors

Affiliations

¹ From the Department of Ophthalmology and Visual Sciences (R.E., M.S., C.J., T.M., A.S., E.S., H.Y., M.C., J.D.L.C., S.J., J.S., E.T., M.R., A.D.), Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
² From the Department of Ophthalmology and Visual Sciences (R.E., M.S., C.J., T.M., A.S., E.S., H.Y., M.C., J.D.L.C., S.J., J.S., E.T., M.R., A.D.), Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; AI.Health4All Center for Health Equity using ML/AI (N.K.), College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; Department of Ophthalmology, University of North Carolina at Chapel Hill, North Carolina, USA. Electronic address: [email protected].
³ Department of Ophthalmology and Visual Sciences (M.W.), University of Michigan Medical School, Ann Arbor, Michigan, USA.
⁴ AI.Health4All Center for Health Equity using ML/AI (N.K.), College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.

PMID: 39617116
DOI: 10.1016/j.ajo.2024.11.023

Abstract

Purpose: To investigate healthcare disparities associated with keratoconus (KCN) patients receiving treatment (corneal cross-linking [CXL] and keratoplasty), as well as comorbidities associated with KCN.

Design: Retrospective clinical cohort study.

Methods: A total of 3224 patients from the University of Illinois Hospital & Health Sciences System (UI-Health) database from 2020 to 2024 were examined, including 1612 patients with an International Classification of Diseases, Tenth Revision diagnosis of KCN, and 1612 ophthalmology patients as a control group. Multivariable and univariable logistic regression were performed to evaluate the associations between sociodemographic traits and rates of CXL and keratoplasty. Sociodemographic traits included age, sex, race/ethnicity, insurance status, and neighborhood social vulnerability. Best corrected visual acuity (BCVA) and manifest cylinder were used as indicators of disease impact. Comorbid disease rates were compared to a 1:1 distance-matched control group. Main outcome measures were odds ratio of undergoing keratoplasty and CXL, and prevalence of comorbid conditions.

Results: Female individuals received less keratoplasty than male individuals (odds ratio [OR] = 0.55, P < .001). Black individuals received less CXL than White individuals (OR = 0.68, P < .05), as did individuals with Medicaid (OR = 0.27, P < .0001) or no insurance (OR = 0.41, P < .001) compared to those with commercial insurance. Individuals from socially vulnerable neighborhoods received less CXL (OR = 0.56, P < .01) and keratoplasty (OR = 0.66, P < .05). Black female individuals were the most vulnerable, undergoing fewer procedures than White female (OR = 0.58, P < .01) and Black male (OR = 0.65, P < .05) individuals. Black and Hispanic/Latin-X individuals presented with more severe disease (P < .01, P < .0001). Down syndrome was more common (P < .01), and diabetes was less common (P < .0001), in KCN patients.

Conclusions: Significant sociodemographic disparities exist in the treatment of KCN. Although further research is necessary, addressing these disparities is crucial for ensuring equitable access to care.