Abstract
PurposeTo understand the impact of socioeconomic status (SES) on the diagnosis of primary open-angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in Taiwan.MethodsSubjects with glaucoma were identified from the National Health Insurance Research Database of year 2006, which included one million randomly selected insurants. Individuals who had ≥4 ambulatory visits within one year which had the diagnosis code of POAG (ICD-9-CM 365.11 or 365.12) or PACG (365.23) and concurrent prescription of anti-glaucoma medication or surgery were selected. Individual SES was represented by monthly income calculated from the insurance premium. Neighborhood SES was defined based on neighborhood household income averages. Urbanization level of habitation was categorized into 3 levels. The odds ratio of having POAG or PACG in subjects with different SES was evaluated by using multiple logistic regression analysis.ResultsIn total, 752 and 561 subjects with POAG and PACG, respectively, who were treated on a regular basis, were identified. The diagnosis of glaucoma was affected by age, gender, frequency of healthcare utilization, individual SES, and urbanization level of habitation. With the adjustment of age, gender, healthcare utilization, neighborhood SES and level of urbanization, subjects with lower income were more likely to be diagnosed as PACG, but less likely as POAG.ConclusionsSubjects with more frequent healthcare utilization were more likely to be diagnosed with glaucoma. Subjects with low SES were more susceptible to PACG, but subjects with high SES were more likely to be diagnosed as POAG. This information is useful for the design and target participant setting in glaucoma education and screening campaign to maximize the efficacy of limited resources in preventing glaucoma blindness.
Highlights
Glaucoma is the leading cause of irreversible blindness
Subjects with low Socioeconomic status (SES) were more susceptible to primary angle closure glaucoma (PACG), but subjects with high SES were more likely to be diagnosed as primary openangle glaucoma (POAG)
This information is useful for the design and target participant setting in glaucoma education and screening campaign to maximize the efficacy of limited resources in preventing glaucoma blindness
Summary
Glaucoma is the leading cause of irreversible blindness. Diagnosis with early intervention may prevent glaucoma blindness.[1.2] Because of the asymptomatic nature of most types of glaucoma, early diagnosis of glaucoma is largely dependent on regular and complete ocular examination. Socioeconomic status (SES) may affect glaucoma awareness, eye care service utilization, healthcare seeking behavior and the chance to identify asymptomatic glaucoma.[3,4,5] Several studies have shown that subjects with lower SES had poorer vision than their better-off counterparts;[6] population-based studies addressing the impact of SES on glaucoma diagnosis are limited. Hospital-based studies revealed that low SES is a risk factor for advanced glaucoma at presentation.[7,8] It is unclear whether the advanced disease at diagnosis in subjects with low SES is the result of delayed diagnosis due to reduced accessibility and use of eye care facility or increased susceptibility
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