Disparities in Eye Health, Care Observed Among North American Native Individuals

Maria A. Woodward, MD

Due to a previous lack of data, a recent study aimed to evaluate the existence of disparities in ophthalmic service and conditions between North American Native individuals and non-Hispanic White individuals in the United States with Medicare coverage.

Led by Maria A. Woodward, MD, Department of Ophthalmology and Visual Sciences, University of Michigan, a team of investigators observed North American Native Individuals had a higher prevalence of ophthalmic conditions, without a corresponding increase in services.

The analysis was performed using billing claims data from The Vision and Eye Health Surveillance System (VEHSS) database for Medicare fee-for-service (MFFS). This identified beneficiaries diagnosed with ophthalmic diseases and receiving treatment.

They included North American Native individuals who identified as American Indian, Native Alaskan, Native Hawaiian, and Pacific Islander. Data from 2017 included all MFFS beneficiaries, consisting of 62% of the Medicare population.

Investigators extracted claims and sociodemographic characteristics and means were computed for categories of ophthalmic conditions and services. The mean claims were calculated for beneficiaries in 5 age groups (0 - 17 years, 18 - 39 years, 40 - 64 years, 65 - 84 years), 2 sex groups (female and male), and 6 first-listed race or ethnicity groups (Asian, non-Hispanic Black, Hispanic, North American Native, non- Hispanic White, and other).

Additionally, they used logistic regression to model differences between age-adjusted mean ophthalmic condition and service claim rates among North American Native population and non-Hispanic White individuals in each age cohort. A match of ophthalmic condition claim rates and service claim rates was also performed to examine disparities by racial group.

The main outcome was defined as mean age-adjusted claim rates for ophthalmic conditions and services among North American Native individuals vs non-Hispanic White individuals per 100 persons.

The analysis identified claims for 177,100 North American Native individuals (0.59%) and 24,438,000 non-Hispanic White individuals (80.82%) from a sample of 30,238,300 individuals (55.29% female).

Data show in 16 of 17 ophthalmic condition categories and 6 of 9 service categories, North American Native individuals had significantly different claim rates in comparison to non-Hispanic White individuals.

They identified higher ophthalmic condition claim rates, but lower service claim rates for North American Native individuals versus non-Hispanic White individuals for refractive errors (ophthalmic condition, 17.2 versus 11.1; service, 48.3 versus 49.6, P <.001), as well as blindness and low vision (ophthalmic condition, 1.48 versus 0.75; service, 19.2 versus 20.1, P <.001).

This continued for injury, burns, and surgical complications (ophthalmic condition, 1.8 versus 1.7; service, 19.2 versus 20.1, P <.001) and orbital and external diseases (ophthalmic condition, 15.7 versus 13.3; service, 48.3 versus 49.6, P <.001).

Then, for diabetic eye diseases, North American Native individuals had higher ophthalmic condition claim rates (5.22 versus 2.20), but they found no difference in service claim rates (14.4 versus 14.8; P = .26) in comparison to non-Hispanic White individuals.

“Future research is needed to determine true prevalence rates of eye disease and eye care utilization in the North American Native population, but North American Native individuals with refractive errors, diabetic eye diseases, and blindness/low vision are surmised to be in greatest need,” investigators wrote.

The study, “Assessing Eye Health and Eye Care Needs Among North American Native Individuals,” was published in JAMA Ophthalmology.