Prevalence and Severity of Glaucoma in the California Medicare Population

Abstract

PurposeTo examine the prevalence of glaucoma by type and severity in the 2019 California (CA) Medicare population, and to identify associated demographic and systemic factors. DesignRetrospective cross-sectional. MethodsThe study population included all 2019 CA Medicare beneficiaries ≥65 years old with Part A and Part B coverage. Outcomes included prevalence of any glaucoma, primary open angle glaucoma (POAG), secondary open angle glaucoma (SOAG), and angle closure glaucoma (ACG). Covariates included age, sex, race and ethnicity, Charlson Comorbidity Index (CCI) score, pseudophakia, and age-related macular degeneration. Logistic regression modeling was used to examine multivariable predictors of each type of glaucoma. ResultsOf 5,856,491 beneficiaries in the 2019 California Medicare population, there were 220,662 (3.8%) with any glaucoma, 171,988 (2.9%) with POAG, 8,827 (0.2%) with SOAG, and 12,978 (0.2%) with ACG. The largest proportion of beneficiaries had moderate to severe glaucoma (68,553/220,662 [31.0%] for any glaucoma moderate stage, 3,168/12,978 [24.4%] for ACG severe stage). Multivariable predictors of any glaucoma included age ≥85 versus 65-69 years (adjusted odds ratio [aOR]=2.03, 95% confidence interval [CI]=2.00, 2.06), female versus male sex (aOR=1.03, 95% CI=1.02, 1.04), Black versus Non-Hispanic White race and ethnicity (aOR=1.70, 95% CI=1.67, 1.73), and CCI ≥5 versus 0 (aOR=5.59, 95%=5.51, 5.67). ConclusionsIn the 2019 CA Medicare population, multiple demographic and systemic factors were associated with increased likelihood of glaucoma, and beneficiaries with glaucoma had high prevalence of moderate to severe disease. Strategies are needed to improve early screening and diagnosis for elderly individuals at risk for glaucoma in California.