Sociodemographic predictors of healthcare utilization and adverse outcomes in Medicare beneficiaries with glaucoma

患有青光眼的医疗保险受益人的医疗保健利用和不良后果的社会人口学预测因素

• 批准号: 10288961
• 负责人: Nazlee Zebardast
• 金额: $ 28.75万
• 依托单位: MASSACHUSETTS EYE AND EAR INFIRMARY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10288961
• 关键词: Accidents; Address; Admission activity; Adverse event; Affect; African American; Age; Aging; Area; Blindness; COVID-19 pandemic; Caring; Characteristics; Chronic; Code; Communities; Complex; Current Procedural Terminology Codes; Data; Diagnosis; Elderly; Eye; Femoral Fractures; Gender; Glaucoma; Health; Health Care Costs; Health Policy; High Prevalence; Hispanics; Home Health Aides; Hospitalization; Individual; Inpatients; International Classification of Diseases; Intervention; Length; Measures; Medicare; Medicine; Mental Depression; Minority; Modeling; Morbidity - disease rate; Nursing Homes; Operative Surgical Procedures; Ophthalmic examination and evaluation; Outcome; Patients; Personal Satisfaction; Physiological; Population; Prevalence; Public Health; Quality of life; Race; Research; Research Personnel; Risk; Risk Factors; Rural; Sampling; Severities; Socioeconomic Factors; Socioeconomic Status; Structure; System; Testing; Time; United States; Vision; Visual impairment; Vulnerable Populations; Work; adverse outcome; base; beneficiary; black patient; burden of illness; care coordination; care outcomes; care providers; care systems; cohort; comorbidity; density; disability; experience; fall injury; falls; follow-up; frailty; health care service utilization; health difference; improved; improved outcome; indexing; low socioeconomic status; mortality; population based; racial disparity; racial minority; risk stratification; rural residence; sex; social deprivation; sociodemographic predictors; sociodemographics; socioeconomic disparity; socioeconomics

PROJECT SUMMARY/ ABSTRACT Patients with glaucoma experience an increased risk of adverse health-related outcomes, including falls, injuries, femur fractures, and depression. In the United States, racial and socioeconomic (SES) disparities exist in glaucoma prevalence, visual impairment, and eye-care utilization. However, we do not know if these disparities result in differences in vision- and health-related outcomes between different groups. Furthermore, while it is known that frailty among older adults has implications for morbidity, mortality, and healthcare costs, the relationship between frailty and healthcare utilization and outcomes in older adults with glaucoma has not been explored. We hypothesize that there are detectable differences on the use of eye care services and subsequently in vision- and health-related outcomes among older adults with glaucoma based on race and SES. We further hypothesize that older adults with a higher frailty score and more comorbidities will be less likely to use eye care services and will have worse vision- and health-related outcomes from glaucoma. To address these hypotheses, we will analyze the existing data from a 5% sample of Medicare beneficiaries from 2014-2016. We will assemble a cohort of glaucoma patients as well as a matched control cohort. Our analyses are aimed at answering 3 specific aims: 1) are there differences in eyecare utilization among older glaucoma patients based on race, SES and frailty and is there an interplay between sociodemographic characteristics and frailty? 2) Are glaucoma patients belonging to vulnerable populations based on race, SES and frailty more likely to experience adverse vision related outcomes? And finally 3) are there differences in health utilization and adverse outcomes among glaucoma patients based on their race and SES? We hypothesize that the impact of glaucoma on overall morbidity and function is unevenly distributed, with vulnerable populations carrying a greater risk or poor health outcomes. The research outlined here will improve our understanding of the complex interplay of factors contributing to disparities in glaucoma care and outcomes. This study will enable us to identify gaps in care among vulnerable populations and identify possible areas for intervention.

项目概要/摘要 青光眼患者出现不良健康相关后果的风险增加，包括跌倒、受伤、 股骨骨折和抑郁症。在美国，种族和社会经济（SES）差异存在于 青光眼患病率、视力障碍和眼部护理利用率。然而，我们不知道这些差异是否 导致不同群体之间视力和健康相关结果的差异。此外，虽然它是 众所周知，老年人的虚弱会对发病率、死亡率和医疗费用产生影响， 患有青光眼的老年人的虚弱与医疗保健利用和结果之间的关系尚未得到证实 探索过。我们假设眼保健服务的使用存在可察觉的差异，随后 基于种族和社会经济地位的青光眼老年人的视力和健康相关结果。我们进一步 假设虚弱评分较高且合并症较多的老年人不太可能使用眼部护理 服务，并且青光眼的视力和健康相关结果会更差。为了解决这些假设， 我们将分析 2014-2016 年 5% 医疗保险受益人样本的现有数据。我们将集合 一组青光眼患者以及一组匹配的对照组。我们的分析旨在回答 3 具体目标：1) 老年青光眼患者对眼保健的利用是否因种族、社会经济地位而存在差异 和虚弱，社会人口特征和虚弱之间是否存在相互作用？ 2）是否是青光眼 属于基于种族、社会经济地位和虚弱的弱势群体的患者更有可能经历不良反应 视力相关的结果？最后 3) 之间的健康利用和不良后果是否存在差异？ 青光眼患者的种族和社会经济地位如何？我们假设青光眼对整体的影响 发病率和功能分布不均，弱势群体面临更大风险或健康状况不佳 结果。这里概述的研究将提高我们对因素复杂相互作用的理解 造成青光眼护理和结果的差异。这项研究将使我们能够确定护理方面的差距 并确定可能的干预领域。