THE ASSOCIATION BETWEEN COMPLEX CATARACT SURGERY AND SOCIAL DETERMINANTS OF HEALTH IN FLORIDA

ABSTRACT

Purpose

To analyze differences between rates of complex and routine cataract surgery based on demographics and social determinants of health (SDOH) at the community level.

Methods

Data from adults ages 18 to 84 relevant to cataract surgery billing codes were extracted from the 2017 Florida Ambulatory Surgery dataset from the Agency for Healthcare Research and Quality merged with SDOH measures from the American Community Survey. A multivariable logistic regression model was used to determine associations between complex cataract surgery and SDOH according to patient ZIP code. Outcomes were reported as odds ratios (OR) with 95% confidence intervals (CI).

Results

A total of 171,754 and 11,340 patients received routine and complex cataract surgeries, respectively; females received the majority of routine surgeries (58.87%); most common age group (79.11%) was from 65 to 84 years. Male (odds ratio [OR] 2.034; p < 0.0001) and black patients (OR 1.998; p < 0.0001) more likely received complex surgery. Compared to Medicare patients, patients insured with Medicaid (OR 2.058; p < 0.0001), private insurance (OR 1.057; p = 0.0182), or self-pay (OR 1.570; p < 0.0001) were more likely to receive a complex surgery. ZIP codes with higher adult poverty (OR 2.614; p < 0.001) were more likely complex surgery patients, whereas those with higher rates of high school attendance (OR 0.487; p = 0.0193) and home occupancy (OR 0.704; p = 0.0047) were less likely to be complex.

Conclusions

Selected patient- and community-level factors including being male, Black, Asian, Hispanic, non-Medicare, or within lower education, higher poverty ZIP codes were associated with a higher likelihood of receiving complex cataract surgery.

KEYWORDS:

• cataract
• social determinants
• health services
• socioeconomic
• minority health

Acknowledgments

1. Funding: Supported by an unrestricted grant from the Illinois Society for the Prevention of Blindness (Chicago, IL) and Research to Prevent Blindness (NY, NY).

2. Financial Disclosures: No competing interests to disclose for any author.

3. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government (Margo, Greenberg, French).

4. Author Contributions: All authors contributed to the overall study design, data collection, management, coding, analysis, and interpretation of results. NM, AW, and DF wrote the manuscript, which was reviewed, revised, and approved by all authors. DF supervised the study, had full access to all the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflicts of interest

None of the authors has any proprietary interests or conflicts of interest related to this submission.

This submission has not been published anywhere previously, and it is not simultaneously being considered for any other publication.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.