Socioeconomic and Demographic Disparities in Keratoconus Treatment

Rohith Erukulla; Mohammad Soleimani; Maria Woodward; Niranjan Karnik; Charlotte Joslin; Timothy McMahon; Angelica Scanzera; Ellen Shorter; Hannah Yoon; Maria Cortina; Jose de la Cruz; Sandeep Jain; Hajirah Saeed; Elmer Tu; Mark Rosenblatt; Ali Djalilian

doi:10.1016/j.ajo.2024.11.023

Socioeconomic and Demographic Disparities in Keratoconus Treatment

Am J Ophthalmol. 2024 Nov 29:S0002-9394(24)00553-1. doi: 10.1016/j.ajo.2024.11.023. Online ahead of print.

Authors

Affiliations

¹ Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, 1855 West Taylor Street, Chicago, Illinois 60612, USA.
² Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, 1855 West Taylor Street, Chicago, Illinois 60612, USA. Electronic address: msolei2@uic.edu.
³ Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1000 Wall Street, Ann Arbor, Michigan 48105, USA.
⁴ AI.Health4All Center for Health Equity using ML/AI, College of Medicine, University of Illinois at Chicago, 1853 W Polk St, Chicago 60612, Illinois.

PMID: 39617116
DOI: 10.1016/j.ajo.2024.11.023

Abstract

Objective: To investigate healthcare disparities associated with keratoconus (KCN) patients receiving treatment (collagen cross-linking (CXL) and keratoplasty), as well as comorbidities associated with KCN.

Design: Retrospective clinical cohort study.

Subjects: 3224 patients from the UI-Health database from 2020 to 2024, including 1612 patients with an ICD-10 diagnosis of KCN and 1612 ophthalmology patients as a control group.

Methods: Multivariable and univariable logistic regression were performed to evaluate association between sociodemographic traits and rates of CXL and keratoplasty. Sociodemographic traits included age, sex, race/ethnicity, insurance status, and neighborhood social vulnerability. Best corrected visual acuity (BCVA) and manifest cylinder were used as indicators of disease impact. Comorbid disease rates were compared to a 1:1 distance-matched control group.

Main outcome measures: Odds ratio of undergoing keratoplasty and CXL, and prevalence of comorbid conditions.

Results: Females received less keratoplasty than males (OR=0.55, P<0.001). Black individuals received less CXL than White individuals (OR=0.68, P<0.05), as did those with Medicaid (OR=0.27, P<0.0001) or no insurance (OR=0.41, P<0.001) compared to those with commercial insurance. Socially vulnerable neighborhoods received less CXL (OR=0.56, P<0.01) and keratoplasty (OR=0.66, P<0.05). Black females were the most vulnerable, undergoing fewer procedures than White females (OR=0.58, P<0.01) and Black males (OR=0.65, P<0.05). Black and Hispanic/Latin-X individuals presented with more severe disease (P<0.01, P<0.0001). Down Syndrome was more common (P<0.01), and diabetes was less common (P<0.0001) in KCN patients.

Conclusions: Significant sociodemographic disparities exist in the treatment of KCN. While further research is necessary, addressing these disparities is crucial for ensuring equitable access to care.

Keywords: CXL; KCN; Keratoconus; corneal cross-linking; corneal transplant; disparity; keratoplasty.