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Race, Ethnicity, Insurance, and Population Density Associations with Pediatric Strabismus and Strabismic Amblyopia in
Anand E Rajesh1, Oliver Davidson1, Megan Lacy1
1Department of Ophthalmology, University of Washington, Seattle, Washington; Roger and Angie Karalis Johnson Retina Center, Seattle, Washington.
Insights
Children with strabismus on Medicaid had more amblyopia and earlier surgery. Racial disparities in strabismus surgery access and timing were observed, with minority children facing delays and reduced likelihood of receiving timely surgical intervention.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Health Services Research
Background:
- Strabismus is a common pediatric eye condition affecting visual development.
- Sociodemographic factors may influence the diagnosis and treatment of pediatric strabismus.
- Understanding these associations is crucial for equitable eye care delivery.
Purpose of the Study:
- To investigate the relationship between sociodemographic factors and the diagnosis and outcomes of pediatric strabismus.
- To identify disparities in strabismus care based on race, ethnicity, insurance, and geographic factors.
Main Methods:
- A retrospective cohort study was conducted using the American Academy of Ophthalmology IRIS® Registry.
- Data included patients diagnosed with strabismus before age 10.
- Multivariable regression and survival analyses examined associations between sociodemographic factors and strabismus diagnosis, amblyopia, and surgery.
Main Results:
- Children with Medicaid insurance had higher odds of amblyopia and underwent surgery sooner than those with commercial insurance.
- Black children with exotropia had higher odds of residual amblyopia compared to White children.
- Black, Hispanic, and Asian children were less likely to receive strabismus surgery and experienced longer delays compared to White children.
Conclusions:
- Medicaid-insured children with strabismus face higher risks of amblyopia and receive surgery more rapidly.
- Significant racial and ethnic disparities exist in pediatric strabismus surgery access and timeliness.
- Addressing these disparities is essential for improving outcomes in pediatric strabismus care.
Purpose:
To evaluate the associations of sociodemographic factors with pediatric strabismus diagnosis and outcomes.
Design:
Retrospective cohort study.
Participants:
American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients with strabismus diagnosed before the age of 10 years.
Methods:
Multivariable regression models evaluated the associations of race and ethnicity, insurance, population density, and ophthalmologist ratio with age at strabismus diagnosis, diagnosis of amblyopia, residual amblyopia, and strabismus surgery. Survival analysis evaluated the same predictors of interest with the outcome of time to strabismus surgery.
Main Outcome Measures:
Age at strabismus diagnosis, rate of amblyopia and residual amblyopia, and rate of and time to strabismus surgery.
Results:
The median age at diagnosis was 5 years (interquartile range, 3-7) for 106 723 children with esotropia (ET) and 54 454 children with exotropia (XT). Amblyopia diagnosis was more likely with Medicaid insurance than commercial insurance (odds ratio [OR], 1.05 for ET; 1.25 for XT; P < 0.01), as was residual amblyopia (OR, 1.70 for ET; 1.53 for XT; P < 0.01). For XT, Black children were more likely to develop residual amblyopia than White children (OR, 1.34; P < 0.01). Children with Medicaid were more likely to undergo surgery and did so sooner after diagnosis (hazard ratio [HR], 1.23 for ET; 1.21 for XT; P < 0.01) than those with commercial insurance. Compared with White children, Black, Hispanic, and Asian children were less likely to undergo ET surgery and received surgery later (all HRs < 0.87; P < 0.01), and Hispanic and Asian children were less likely to undergo XT surgery and received surgery later (all HRs < 0.85; P < 0.01). Increasing population density and clinician ratio were associated with lower HR for ET surgery (P < 0.01).
Conclusions:
Children with strabismus covered by Medicaid insurance had increased odds of amblyopia and underwent strabismus surgery sooner after diagnosis compared with children covered by commercial insurance. After adjusting for insurance status, Black, Hispanic, and Asian children were less likely to receive strabismus surgery with a longer delay between diagnosis and surgery compared with White children.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
