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Original Investigation
May 2, 2018

Characteristics Associated With Receiving Cataract Surgery in the US Medicare and Veterans Health Administration Populations

Author Affiliations
  • 1Warren Alpert Medical School of Brown University, Providence, Rhode Island
  • 2Stein Eye Institute, David Geffen School of Medicine, UCLA (University of California, Los Angeles)
  • 3Department of Epidemiology, Fielding School of Public Health, UCLA
  • 4Section of Ophthalmology, Veterans Affairs Medical Center, Providence, Rhode -Island
  • 5Ophthalmology Division, West Los Angeles Veterans Affairs Medical Center, Los Angeles, California
  • 6Department of Biostatistics, Fielding School of Public Health, UCLA
  • 7American Academy of Ophthalmology, San Francisco, California
JAMA Ophthalmol. Published online May 2, 2018. doi:10.1001/jamaophthalmol.2018.1361
Key Points

Question  What characteristics are associated with receiving cataract surgery within the US Medicare and Veterans Health Administration patient populations?

Findings  In this cohort study of 1.2 million Medicare patients and 1.9 million Veterans Health Association patients, a greater proportion of Medicare patients received cataract surgery within 1 and 5 years of cataract diagnosis. Within both groups, older vs younger age, residence in the southern vs other parts of the United States, and chronic pulmonary disease vs no such disease were associated with increased odds of cataract surgery at 1 and 5 years after diagnosis.

Meaning  Although a larger proportion of Medicare patients with cataract underwent surgery, both patient populations had similar characteristics associated with receiving cataract surgery.

Abstract

Importance  Considerable variation exists with respect to the profiles of patients who receive cataract surgery in the United States.

Objective  To identify patient characteristics associated with receiving cataract surgery within the US Medicare and Veterans Health Administration (VHA) populations.

Design, Setting, and Participants  In this population-based retrospective cohort study of 3 073 465 patients, Medicare and VHA patients with a cataract diagnosis between January 1, 2002, and January 1, 2012, were identified from the 2002-2012 Medicare Part B files (5% sample) and the VHA National Patient Care Database. Patient age, sex, race/ethnicity, region of residence, Charlson Comorbidity Index (CCI) scores, and comorbidities were recorded. Cataract surgery at 1 and 5 years after diagnosis was identified. Data analysis was performed from July 1, 2016, to July 1, 2017.

Main Outcomes and Measures  Odds ratios (ORs) of cataract surgery for selected patient characteristics.

Results  The study sample included 1 156 211 Medicare patients (mean [SD] age, 73.7 [7.0] years) and 1 917 254 VHA patients (mean [SD] age, 66.8 [10.2] years) with a cataract diagnosis. Of the 1 156 211 Medicare patients, 407 103 (35.2%) were 65 to 69 years old, 683 036 (59.1%) were female, and 1 012 670 (87.6%) were white. Of the 1 917 254 VHA patients, 905 455 (47.2%) were younger than 65 years, 1 852 158 (96.6%) were male, and 539 569 (28.1%) were white. A greater proportion of Medicare patients underwent cataract surgery at 1 year (Medicare: 213 589 [18.5%]; VHA: 120 196 [6.3%]) and 5 years (Medicare: 414 586 [35.9%]; VHA: 240 884 [12.6%]) after diagnosis. Factors associated with the greatest odds of surgery at 5 years were older age per 5-year increase (Medicare: OR, 1.24 [95% CI, 1.23-1.24]; VHA: OR, 1.18 [95% CI, 1.17-1.18]), residence in the southern United States vs eastern United States (Medicare: OR, 1.38 [95% CI, 1.36-1.40]; VHA: OR, 1.40 [95% CI, 1.38-1.41]), and presence of chronic pulmonary disease (Medicare: OR, 1.26 [95% CI, 1.24-1.27]; VHA: OR, 1.40 [95% CI, 1.38-1.41]). Within Medicare, female sex was associated with greater odds of surgery at 5 years (OR, 1.14; 95% CI, 1.13-1.15). Higher CCI scores (CCI score ≥3 vs 0-2) were associated with increased odds of surgery among VHA but not Medicare patients at 5 years (Medicare: OR, 0.94 [95% CI, 0.92-0.95]; VHA: OR, 1.24 [95% CI, 1.23-1.36]). Black race vs white race was associated with decreased odds of cataract surgery 5 years after diagnosis (Medicare: OR, 0.79 [95% CI, 0.78-0.81]; VHA: OR, 0.75 [95% CI, 0.73-0.76]).

Conclusions and Relevance  Within both groups, older age, residence in the southern United States, and presence of chronic pulmonary disease were associated with increased odds of cataract surgery. Findings from this study suggest that few disparities exist between the types of patients receiving cataract surgery who are in Medicare vs the VHA, although it is possible that a smaller proportion of VHA patients receive surgery compared with Medicare patients.

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