Medicare Patients More Likely to Undergo Cataract Surgery
JAMA Ophthalmology, July 2018
In a study of patients with cataract enrolled in Medicare or the Veterans Health Administration (VHA), Wu et al. discerned and compared the factors associated with receiving cataract surgery. Although patient characteristics were found to be similar in these health systems, substantially more Medicare patients underwent the surgery.
The study involved more than 3 million patients with cataract, diagnosed during a 10-year period. Patients were identified from Medicare Part B files (5% sample) and the VHA National Patient Care Database. Collected data included demographics, Charlson Comorbidity Index (CCI) scores, and comorbidities. The association of these variables with attaining cataract surgery was assessed. The authors tallied the number of patients in each health system who received cataract surgery within 1 and 5 years of cataract diagnosis.
Roughly 1.2 million patients were Medicare members (mean age, 73.7 years) and 1.9 million were VHA members (mean age, 66.8 years). Among the Medicare group, more than a third were 65 to 69 years of age, 59% were female, and 88% were white. VHA members tended to be younger (47% were younger than 65) and male (97%) and were less likely to be white (28%). Within 1 year of cataract diagnosis, a larger percentage of Medicare patients had undergone the surgery (18.5% vs. 6.3% of VHA patients); the disparity was similar at the 5-year mark (35.9% vs. 12.6%).
Factors associated with attaining surgery within 5 years of diagnosis were older age per 5-year increase (Medicare odds ratio [OR], 1.24; VHA OR, 1.18), residence in the southern vs. eastern United States (Medicare OR, 1.38; VHA OR, 1.40), and coexisting chronic pulmonary disease (Medicare OR, 1.26; VHA OR, 1.40). In the Medicare group, female sex was associated with greater likelihood of surgery within 5 years (OR, 1.14). Higher CCI scores (≥3 vs. 0-2) correlated with better odds of surgery within 5 years among VHA members but not Medicare members (Medicare OR, 0.94; VHA OR, 1.24). Black (vs. white) race was linked to lower likelihood of cataract surgery within 5 years of diagnosis (Medicare OR, 0.79; VHA OR, 0.75). (Also see related commentary by Kristina B. Lindsley, MS, in the same issue.)
The original article can be found here.