Angela R. Elam|Chris Andrews|David C. Musch|Paul P. Lee|Joshua D. Stein
Large Disparities in Receipt of Glaucoma Care between Enrollees in Medicaid and Those with Commercial Health Insurance
University of Michigan–Ann Arbor|University of Michigan–Ann Arbor|University of Michigan–Ann Arbor|University of Michigan–Ann Arbor|University of Michigan–Ann Arbor
purpose determine whether type health insurance patient possesses patients raceethnicity affect receipt common tests monitor openangle glaucoma oag design retrospective longitudinal cohort study participants total 21 766 persons aged 40 years newly diagnosed oag 2007 2011 enrolled medicaid large united states managed care network methods determined proportion patients newly diagnosed oag underwent visual field vf testing fundus photography fp ocular imaging ooi none tests within first 15 months initial oag diagnosis multivariable logistic regression used assess extent health insurance type raceethnicity affected odds undergoing glaucoma testing main outcome measures odds ratios undergoing vf testing fp ooi none tests 15 months initial oag diagnosis 95 confidence intervals ci results total 18 372 persons commercial health insurance 3394 medicaid recipients met study inclusion criteria proportions persons commercial health insurance newly diagnosed oag underwent vf fp ooi 63 22 54 respectively whereas proportions 35 19 30 respectively medicaid recipients compared commercial health insurance medicaid recipients 234 likely receive glaucoma testing 15 months initial diagnosis 334 95 ci 307363 adjustment confounders whites oag enrolled medicaid 198 higher odds receiving glaucoma testing compared whites possessing commercial health insurance 298 95 ci 266333 blacks medicaid insurance demonstrated 291 higher odds 391 95 ci 340449 receiving glaucoma testing compared blacks commercial health insurance conclusions irrespective raceethnicity medicaid recipients oag receiving substantially less glaucoma testing compared persons commercial health insurance disparities testing observed across racesethnicities notable blacks findings particularly disconcerting blacks likely whites go blind oag disproportionately blacks medicaid efforts needed improve quality glaucoma care medicaid recipients especially racial minorities determine whether type health insurance patient possesses patients raceethnicity affect receipt common tests monitor openangle glaucoma oag retrospective longitudinal cohort study total 21 766 persons aged 40 years newly diagnosed oag 2007 2011 enrolled medicaid large united states managed care network determined proportion patients newly diagnosed oag underwent visual field vf testing fundus photography fp ocular imaging ooi none tests within first 15 months initial oag diagnosis multivariable logistic regression used assess extent health insurance type raceethnicity affected odds undergoing glaucoma testing odds ratios undergoing vf testing fp ooi none tests 15 months initial oag diagnosis 95 confidence intervals ci total 18 372 persons commercial health insurance 3394 medicaid recipients met study inclusion criteria proportions persons commercial health insurance newly diagnosed oag underwent vf fp ooi 63 22 54 respectively whereas proportions 35 19 30 respectively medicaid recipients compared commercial health insurance medicaid recipients 234 likely receive glaucoma testing 15 months initial diagnosis 334 95 ci 307363 adjustment confounders whites oag enrolled medicaid 198 higher odds receiving glaucoma testing compared whites possessing commercial health insurance 298 95 ci 266333 blacks medicaid insurance demonstrated 291 higher odds 391 95 ci 340449 receiving glaucoma testing compared blacks commercial health insurance irrespective raceethnicity medicaid recipients oag receiving substantially less glaucoma testing compared persons commercial health insurance disparities testing observed across racesethnicities notable blacks findings particularly disconcerting blacks likely whites go blind oag disproportionately blacks medicaid efforts needed improve quality glaucoma care medicaid recipients especially racial minorities