Socioeconomic and Demographic Disparities in Keratoconus Treatment

• Published in: American journal of ophthalmology 2024-11
• Main Authors: Erukulla, Rohith, Soleimani, Mohammad, Woodward, Maria, Karnik, Niranjan, Joslin, Charlotte, McMahon, Timothy, Scanzera, Angelica, Shorter, Ellen, Yoon, Hannah, Cortina, Maria, Cruz, Jose de la, Jain, Sandeep, Saeed, Hajirah, Tu, Elmer, Rosenblatt, Mark, Djalilian, Ali
• Format: Article
• Language: English
• Subjects: corneal cross-linking; corneal transplant; CXL; disparity; KCN; Keratoconus; keratoplasty
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2024.11.023

•Females undergo less keratoplasty•Black, Medicaid, and uninsured patients receive less collagen cross-linking (CXL)•Individuals from socially vulnerable neighborhoods experience less CXL and keratoplasty•Black and Hispanic patients experience more severe keratoconus (KCN) on average•Black females are the subgroup most vulnerable to KCN treatment disparity To investigate healthcare disparities associated with keratoconus (KCN) patients receiving treatment (collagen cross-linking (CXL) and keratoplasty), as well as comorbidities associated with KCN. Retrospective clinical cohort study. 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. 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. Odds ratio of undergoing keratoplasty and CXL, and prevalence of comorbid conditions. Females received less keratoplasty than males (OR=0.55, P