Risk of physical injuries in children and teens with ophthalmic diagnoses in the OptumLabs Data Warehouse

Abstract

To evaluate how eye diseases affect the risk of injuries (fractures, musculoskeletal, head and eye injuries) in children and teens. Claims from the OptumLabs Data Warehouse, a longitudinal deidentified commercial insurance claims database, were analyzed. Eligible subjects were aged <19years at the time of their eye disease diagnosis, enrolled in the health plan between 2007 and 2018, and had >1 visit for >1 significant eye disease (strabismus, amblyopia, nystagmus, structural diseases), based on ICD9/10 codes. Controls were children in the same database who had no eye disease codes reported. Demographics and injury claims (fractures, musculoskeletal injuries, head injuries and eye injuries) were compared. The overall incidence of any subsequent physical injury (even into adulthood) was 29% in eye disease patients and 23% in controls (P<0.001). After accounting for covariates, the hazard ratio for injury with any type of eye disease was 1.14 (95% CI, 1.13-1.15), 1.17 (95% CI, 1.16-1.18), 0.97 (95% CI, 0.96-0.98), and 1.63 (95% CI, 1.60-1.66) for musculoskeletal injuries, fractures, head injuries, and eye injuries, respectively. The eye disease with the highest adjusted injury risk was nystagmus (HR=1.26; 95% CI, 1.23-1.28), followed by optic neuritis and pseudotumor cerebri (HR=1.25). The eye diseases with the lowest risk included amblyopia, esotropia, and glaucoma (HR≤1.06). There was an increased long-term risk of physical injury among children and teens with eye disease. The clinical significance of these small differences is unclear.