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Health Disparities

Assessing Eye Health and Eye Care Needs Among North American Native Individuals

Educational Objective
To evaluate whether disparities in ophthalmic conditions and services exist between North American Native individuals and non-Hispanic White individuals in the US.

1 Credit CME

JAMA Ophthalmology

Published Online: December 23, 2021

Original Investigation

Article Information and Disclosures

Maria A. Woodward, MD, MSc^1,2;

Kathleen Hughes, MBA³;

Dena Ballouz, MD¹;

Richard A. Hirth, PhD^2,4;

Josh Errickson, PhD⁵;

Paula Anne Newman-Casey, MD, MSc^1,2

Author Affiliations

¹Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
²Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
³Avalere Health, Washington, DC
⁴Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
⁵Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor

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Key Points

Question Are there disparities in ophthalmic conditions and services between North American Native individuals and non-Hispanic White individuals in the US?

Findings In this cross-sectional study, higher condition claim rates but lower service claim rates were found for North American Native individuals vs non-Hispanic White individuals for refractive errors; diabetic eye diseases; blindness and low vision; injury, burns, and surgical complications of the eye; and orbital and external disease, suggesting disparities in eye care among North American Native individuals.

Meaning These findings support the need for policy changes and further research to explain and address disparities in eye care among North American Native individuals compared with non-Hispanic White individuals.

Abstract

Importance There are few population-level studies on ophthalmic conditions and services among North American Native individuals.

Objective To evaluate whether disparities in ophthalmic conditions and services exist between North American Native individuals and non-Hispanic White individuals in the US.

Design, Setting, and Participants This cross-sectional study used 100% Medicare fee-for-service (MFFS) enrollment data from the Vision and Eye Health Surveillance System (VEHSS) to examine ophthalmic conditions and service use in North American Native individuals and non-Hispanic White individuals in the US. In this study North American Native individuals included those who identified as American Indian, Native Alaskan, Native Hawaiian, and Pacific Islander. Data were analyzed from August 2020 to April 2021.

Interventions Claims and sociodemographic characteristics were extracted and means computed for categories of ophthalmic conditions and select ophthalmic services. Ophthalmic conditions and services were defined in the VEHSS using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Logistic regression was used to model differences between age-adjusted mean ophthalmic condition and service claim rates among North American Native individuals and non-Hispanic White individuals for each age cohort. Matching ophthalmic condition claim rates and ophthalmic service claim rates was performed to examine disparities by racial group.

Main Outcomes and Measures Mean age-adjusted claim rates for ophthalmic conditions and services among North American Native individuals vs non-Hispanic White individuals per 100 persons.

Results Claims were identified for 177 100 Native American Native individuals and 24 438 000 non-Hispanic White individuals. In 16 of 17 ophthalmic condition categories and 6 of 9 service categories, North American Native individuals had significantly different claim rates from non-Hispanic White individuals. There were higher ophthalmic condition claim rates but lower service claim rates for North American Native individuals (vs non-Hispanic White individuals) for refractive errors (ophthalmic condition, 17.2 vs 11.1; service, 48.3 vs 49.6, respectively; P < .001); blindness and low vision (ophthalmic condition, 1.48 vs 0.75: service, 19.2 vs 20.1, respectively; P < .001); injury, burns, and surgical complications (ophthalmic condition, 1.8 vs 1.7; service, 19.2 vs 20.1, respectively; P < .001); and orbital and external disease (ophthalmic condition, 15.7 vs 13.3; service, 48.3 vs 49.6, respectively; P < .001). For diabetic eye diseases, North American Native individuals had higher ophthalmic condition claim rates (5.22 vs 2.20) but no difference in service claim rates (14.4 vs 14.8; P = .26) compared with non-Hispanic White individuals.

Conclusions and Relevance In this cross-sectional study, North American Native individuals had higher prevalence of ophthalmic conditions but no corresponding increase in services (treatment for most ophthalmic conditions) compared with non-Hispanic White individuals. These results suggest worse eye health and higher unmet eyecare needs for North American Native individuals with MFFS coverage compared with non-Hispanic White individuals with MFFS coverage.

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Article Information

Accepted for Publication: November 2, 2021.

Published Online: December 23, 2021. doi:10.1001/jamaophthalmol.2021.5507

Corresponding Author: Maria A. Woodward, MD, MSc, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall St, Ann Arbor, MI 48105 (mariawoo@med.umich.edu).

Author Contributions: Dr Woodward had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Woodward, Hirth, Newman-Casey.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Woodward, Hughes, Ballouz, Hirth, Newman-Casey.

Critical revision of the manuscript for important intellectual content: Woodward, Ballouz, Hirth, Errickson, Newman-Casey.

Statistical analysis: Woodward, Ballouz, Hirth, Errickson.

Obtained funding: Woodward, Hughes, Hirth, Newman-Casey.

Administrative, technical, or material support: Woodward.

Supervision: Woodward, Newman-Casey.

Conflicts of Interest Disclosures: Dr Woodward, Ms Hughes and Drs Hirth and Newman-Casey report grants from Seva Foundation during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was supported by the Seva Foundation (Dr Woodward, Ms Hughes, Drs Hirth, Errickson, and Newman-Casey); National Eye Institute (R01EY031337 to Dr Newman-Casey and R01EY031033 to Dr Woodward), and a Research to Prevent Blindness Career Development Award (Dr Woodward).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Meeting Presentation: This material was presented at the Association for Research in Vision and Ophthalmology Annual Meeting; May 2021; virtual meeting.

Additional Contributions: This project was supported in part by a gift by Ms Susan Lane and assistance in study development by Jennifer Huang, MD, University of California Irvine, who was not compensated for her contributions.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.