Demographic Disparities in the Likelihood of Surgical Repair Following Diagnosis of Rhegmatogenous Retinal Detachment.

Abstract

This US-based large-scale retrospective study explores whether demographic differences influence likelihood to surgical intervention after a diagnosis of rhegmatogenous retinal detachment (RRD). Retrospective Cohort Study SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Patients with ICD-10 encounter diagnosis codes for RRD METHODS, INTERVENTION, OR TESTING: Through a de-identified electronic health record platform, RRD patients were separated into sex, race, ethnicity, and socioeconomic/psychosocial (SES) cohorts. Pair-wise comparisons were made after 1:1 propensity score matching (PSM) on age, ocular conditions, socioeconomic/psychosocial conditions, and systemic and lifestyle comorbidities. Patients likelihood of CPT code for RRD repair surgery at 4 timepoints (within 1 day, 1 week, 1 month, 3 months) following RRD was assessed. Risk ratios (RR) and 95% confidence intervals (CI) were reported with a significance threshold <0.9 or >1.1. Following PSM, there were 21756 patients in the male versus female analysis, 5071 in the White versus Black, 1903 in the White versus Asian, 3279 in the Hispanic versus non-Hispanic, and 2194 in the socioeconomic/psychosocial analysis. Males were more likely to receive surgery within 1 day (RR 1.20, 95% CI: 1.15, 1.24) up to 3 months after RRD (RR 1.19, 95% CI 1.15, 1.23). Compared to Black patients, White patients were more likely to receive surgery within 1 day (RR 1.47, 95% CI 1.35, 1.61) up to 3 months (RR 1.36, 95% CI 1.26, 1.46) after RRD. Both White versus Asian patients and Non-Hispanic/Latinos versus Hispanic/Latinos did not have significant differences in time to surgery. Patients without socioeconomic/psychosocial (SES) conditions were more likely to receive surgery at 1 day (RR 3.35, 95% CI 2.73, 4.10) up to 3 months (RR 2.83, 95% CI 2.41, 3.34) after RRD. A sensitivity analysis performed between female patients ± SES as well as black patients ± SES yielded increased differences. Comparison between patients with reported and unreported race and ethnicity also demonstrated differences up to 3 months. Males are more likely to receive surgical intervention for RRD. Significant racial disparities exist in timely RRD repair for Black patients and patients with SES conditions. This study highlights continued disparities that exist in RRD management.