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Surgical Undertreatment of Glaucoma in Black Beneficiaries of Medicare
Uday Devgan, MD;
Fei Yu, MS;
Eric Kim;
Anne L. Coleman, MD, PhD
Arch Ophthalmol. 2000;118:253-256.
Objective To identify whether there was surgical undertreatment of glaucoma in black beneficiaries of Medicare from 1991 to 1994.
Methods We performed a retrospective cohort analysis on all argon laser trabeculoplasty or trabeculectomy surgery claims to the Health Care Financing Administration between 1991 and 1994. There were 191,287 Medicare patients who were black or white, at least 65 years of age, and resided in the United States at the time of their glaucoma surgery. Age- and sex-adjusted rates were obtained and compared with surgery rates expected based on disease prevalence.
Results The age-sex–adjusted rate ratio of glaucoma surgical procedures for blacks to whites was 2.14. Assuming that treatments should be done in proportion to age-race prevalence, blacks undergo glaucoma surgery at approximately 47% below the expected rate.
Conclusions Blacks underwent argon laser trabeculoplasties and trabeculectomies at half the rate of whites from 1991 to 1994. Although in 1993 and 1994 there was a slight trend toward higher surgery rates in blacks, the magnitude of this improvement was small compared with estimated differences in the surgery rates between blacks and whites.
From the Jules Stein Eye Institute and the Department of Ophthalmology, UCLA School of Medicine, Los Angeles, Calif (Drs Devgan and Coleman and Mr Yu), the UCLA School of Public Health (Mr Yu), and the University of California, College of Letters and Science, Berkeley (Mr Kim).
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