Keywords: ocular trauma, trauma, access

Background: Traumatic ocular injuries are a leading cause of monocular blindness in the United States. Previous studies estimate that approximately 24.5 million people in the United States have experienced an eye injury with 13.6% experiencing visual impairment. Identification of the most vulnerable groups to experience ocular trauma is essential to the creation of preventative devices and programs, identifying where acute eye care services are needed and to decrease disparities in treatment for ocular injury.

Purpose: To examine the prevalence of ocular trauma and its association with the Center for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry’s Social Vulnerability Index (SVI) in the 2019 California Medicare population.

Methods: The study population included all 2019 CA Medicare beneficiaries. The outcome variable included at least one claim for a diagnosis of ocular trauma defined by the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Codes (S04 – S05). The exposure was SVI quartile of which was determined via 2018 American Community Survey data based on beneficiary zip code. Covariates included age, race (defined as Black/African American, Asian American, Hispanic, Non-White Hispanic, and other), Charlson Comorbidity Index (CCI), and sex. Logistic regression models assessed the association between SVI quartile and prevalence of ocular trauma, adjusting for all covariates.

Results: The study included 2,649,107 beneficiaries, of whom 24,179 (0.91%) had ocular trauma. Of those with ocular trauma, the greatest proportion were those aged ≥85 (5,648/24,179 [23.4%]); identify as female (14,354/24,179 [59.4%]); and are Non-Hispanic White (17,122/24,179 [70.8%]).  The SVI quartile for beneficiaries with ocular trauma was 28.8% (6,974/24,179) for Q1; 27.7% (6,689/24,179) for Q2; 23.7% (5,730/24,179) for Q3, and 19.8% (4,786/24,179) for Q4. In logistic regression models, beneficiaries within higher SVI quartiles had lower odds of ocular trauma ([Q2 vs. Q1 – aOR: 0.91, 95% CI: 0.88-0.94, p<0.0001]; [Q3 vs. Q1 – aOR: 0.79, 95% CI: 0.77-0.82, p<0.00001]; [Q4 vs. Q1 – aOR: 0.68, 95% CI: 0.66-0.71, p<0.00001]).

Conclusions: In the 2019 CA Medicare population, beneficiaries with more social vulnerability had lower prevalence of ocular trauma compared to those with less vulnerability. Further studies are needed to examine if these findings are due to underdiagnosis and underreporting of ocular trauma in individuals with a high level of social vulnerability and potentially decreased access to urgent ophthalmic care.