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The Longitudinal Pattern of Care

Jan Ostermann, PhD; Frank A. Sloan, PhD; Leon Herndon, MD; Paul P. Lee, MD, JD

Arch Ophthalmol. 2005;123:1693-1698.

Objective  To examine if racial differences exist in longitudinal care patterns for Medicare beneficiaries with glaucoma.

Methods  We analyzed national longitudinal Medicare claims data from January 1, 1991, through December 31, 1999 in 21 644 Medicare beneficiaries linked to the National Long-Term Care Survey. Logistic regression was used to predict whether a person underwent an eye examination or eye surgery during the year, and negative binomial regression was used to predict the number of eye examinations and surgical procedures for glaucoma per year. Annual use of eye examinations was nearly identical for black persons (1.85 per year) and white persons (1.89 per year), whereas surgery rates were higher among blacks (0.15) than whites (0.08, P<.001).

Results  Blacks were more likely than whites to have glaucoma diagnosed, but rates among whites were higher than in prior population-based studies. When we controlled for other factors, blacks were not significantly less likely to undergo eye examination during the year; however, blacks were 78% more likely to undergo surgery (P < .001) and had 76% higher rates of surgical procedures (P < .001).

Conclusions  No systematic pattern was found of underuse among blacks relative to whites after glaucoma diagnosis. Higher rates of surgery among blacks may indicate delayed onset of care and/or greater disease severity.

Author Affiliations: Center for Health Policy, Law, and Management (Drs Ostermann and Sloan), Departments of Economics (Dr Sloan) and Ophthalmology (Drs Herndon and Lee), Duke University Medical School, Durham, NC; and RAND, Health Sciences Program, Santa Monica, Calif (Dr Lee).

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