Racial, Ethnic Disparities in Ocular Comorbidities Impact US Mortality

Rajeev H. Muni, MD, MSc

Credit: Unity Health Toronto

New research identified significant racial and ethnic disparities in the prevalence of ocular comorbidities contributing to death in the United States over a 20-year period.¹

Noteworthy increases in the prevalence of ocular comorbidities among American Indian or Alaska Native and Hispanic individuals were observed in the cross-sectional analysis. Previous reports suggest more than half of Latino individuals with eye disease had no history of disease, with the highest rates of people without insurance.²

“Given the decrease in uninsured individuals, it is plausible that improving disease documentation over the last 2 decades partly accounted for the increase in ocular comorbidities contributing to death,” wrote the investigative team, led by Rajeev H. Muni, MD, MSc of the department of ophthalmology, St Michael’s Hospital, Unity Health Toronto.¹

More than 200 million individuals are estimated to have visual impairment, a factor that has been linked to higher mortality rates. However, Muni and colleagues noted there is a shortage of data on ocular comorbidities as a contributor to US deaths. In this population-based analysis, investigators provided comprehensive estimates of ocular comorbidities contributing to death in the US.

Using mortality records from the US Centers for Disease Control and Prevention (CDC), the cross-sectional study identified race and ethnicity to analyze the differences between groups in ocular comorbidities contributing to death. All deaths occurring between January 2000 - December 2019 listing ocular diseases as a contributing factor were extracted and included in the analysis.

For analysis, the number of ocular comorbidities contributing to US deaths was computed per 100,000 deaths annually over the study period (2000-2019). Univariable linear regression models allowed investigators to examine trends in ocular comorbidities prevalence over the period as well.

Over the 20-year period, a total of 51,125,902 deaths were reported in the US. Higher rates were observed among men (50.1%), White individuals (79.6%), and individuals aged 80 to 89 years (28.5%). Upon analysis, investigators found 51,256 deaths associated with a medically confirmed ocular comorbidity (1 per 1000).

The team noted the deaths related to ocular comorbidities were most common among individuals aged 90 to 99 years (35.3%) and women (62.2%). Most ocular comorbidities contributing to death were observed among White individuals (81.8%), particularly age-related macular degeneration (AMD), compared with other racial and ethnic groups, including American Indian or Alaska Native (0.5%), Asian or Pacific Islander (1.7%), Black (11.2%), or Hispanic (4.8%). Binocular blindness was the most frequent contributor to death among American Indian or Alaska Native and Hispanic individuals.

Additional findings showed the number of ocular comorbidities contributing to death decreased overall by 1.7% from 2000 (n = 2849) to 2019 (n = 2801). Decreases of 17.1% (n = 369 to 306) and 6.5% (n = 2366 to 2213) were observed among Black and White individuals, respectively.

The data also showed a significant trend in increased prevalence of ocular comorbidities contributing to death among American Indian and Alaska Native and Hispanic individuals. Increases of 166.7% (n = 6 to 16) and 194.0% (n = 67 to 197) were observed for each group, respectively.

Muni and colleagues indicated previous reports validating death certificate reporting in the US reported a lack of notable mortality differentials by race and ethnicity after adjustment for misclassification.³ The study period used in this analysis represented the longest, contiguous period for which the CDC utilized the same ICD-10 codes, limiting the risk of misclassification of death.¹

“The large sample size and population-based nature of this study allowed for generalizability of our findings to the US civilian population,” investigators wrote.

References

1. Huang RS, Mihalache A, Popovic MM, Kertes PJ, Wong DT, Muni RH. Ocular Comorbidities Contributing to Death in the US. JAMA Netw Open. 2023;6(8):e2331018. doi:10.1001/jamanetworkopen.2023.31018
2. Gong F. Racial and ethnic disparities in health insurance coverage in the USA: findings from the 2018 National Health Interview Survey. J Racial Ethn Health Disparities. 2023;10(2):651-659. doi:10.1007/s40615-022-01253-2
3. Arias E, Schauman WS, Eschbach K, Sorlie PD, Backlund E. The validity of race and Hispanic origin reporting on death certificates in the United States. Vital Health Stat 2. 2008;(148):1-23