Fei Yu, Hamid Hosseini, Anne L Coleman
Racial/ethnic disparities in diabetic retinopathy treatment among California Medicare beneficiaries.
Background: Diabetic retinopathy (DR) is among the most common diabetic related complication causing irreversible vision loss that affects 29% of US adults aged >40 years. Within the Medicare population, incidence of DR among Hispanic and African Americans is high but little research shows if disparities exist in the types of treatment they receive.
Purpose: To describe the racial/ethnic differences of DR treatment in Medicare DR patients in California.
Methods: Using the Medicare Part-B carriers claims databases from the Centers for Medicare and Medicaid Services (CMS), we identified all diabetic Medicare California beneficiaries in 2017 by International Classification of Diseases 10th Revision, Clinical Modification (ICD-10-CM) codes (E08, E09, E10, E11, E13) along with type 1 and type 2 diabetics with retinopathy (E10.3, E11.3 respectively). The inclusion criteria were those who resided in CA in 2017, age 65 years or older, enrolled in Medicare part A and part B, and had at least 1 part B claim in 2017. Patients’ age, gender and race were collected. Current Procedural Terminology (CPT) codes for intravitreal injection (67028), focal laser (67210), panretinal photocoagulation (PRP, 67228) and vitrectomy (67036) were used to identify the mode of treatment for each patient. Multivariable logistic regression models were used to determine the association between demographics and DR treatment by including all demographic variables, and the effect estimates were expressed as odds ratios (OR) with 95% confidence intervals (CI).
Results: Among 772,686 diabetic patients who met the inclusion criteria, a total of 83,085 (10.7%) had some form of proliferative and/or non-proliferative DR. Most DR patients were type 2 diabetics (97.4%), aged 65-69 (26.8%) or 70-74 (25.7%), females (54.1%), and white (36.9%) or Hispanic (34.2%). Compared with white Medicare DR patients, Hispanics had similar odds of receiving intravitreal injections (OR=0.99, 95% CI: 0.94, 1.03), while there was a lower odds in black (OR=0.83, 95% CI: 0.75, 0.91), Asian (OR=0.65, 95% CI: 0.61, 0.69), and other races (OR=0.83, 95% CI: 0.75, 0.92). Compared with white, non-white patients have higher likelihood of receiving focal laser and PRP (black: OR=1.23 and OR=1.68, respectively; Asian: OR=1.19 and OR=1.40, respectively; Hispanic: OR=1.84 and OR=2.27, respectively; other races: OR=1.34 and OR=1.44, respectively). Surgical intervention with vitrectomy was not statistically significantly different among racial subgroups.
Conclusions: Despite increased incidence of DR among non-white Medicare beneficiaries, racial disparities may persist in treatment modalities. Not only are non-white Medicare beneficiaries receiving fewer eye examinations as reported in the literature, but also receiving more laser therapy suggesting advanced DR burden.