Socioeconomic and Racial Disparities in Primary Open Angle Glaucoma in the United States

Socioeconomic status is a potentially significant, although difficult to isolate, factor in determining glaucoma severity.

To analyze the level of glaucoma severity (mild, moderate, or severe) based on demographic factors, including age, gender, ethnicity, insurance profile, and zip code, and to use this data to extrapolate the effect of socioeconomic status (SES) and race on glaucoma severity at the community level in Memphis, TN.

Totally, 2913 patients from a tertiary care center with 3 clinic locations in Memphis, TN who had been given the diagnosis of primary open angle glaucoma (POAG) through use of the ICD-10 codes for mild (H40.1111, H40.1121, H40.1131), moderate (H40.1112, H40.1122, H40.1132), and severe (H40.1113, H40.1123, H40.1133) POAG between January 2016 and July 2021 were included in this study. Diagnoses were made after a complete glaucoma workup consisting of Snellen visual acuity, applanation IOP measurement, gonioscopy, automated Humphreys visual fields (10-2 and 24-2), and optic nerve OCT. Demographic information, including age, gender, ethnicity, insurance profile, and zip code, was also collected with disease severity for each patient. SES was approximated using zip code-level census poverty data and insurance profiles. Statistical analyses were performed, including descriptive, multivariable ordinal logistic modeling, and stepwise multivariable linear modeling.

Glaucoma severity was shown to increase with poverty rate (OR=1.089, P <0.0071), age (OR=1.030, P <0.0001), male sex (OR=1.374, P <0.0001), and Black race (OR=1.896, P <0.0001). Severity was shown to be decreased in patients with private insurance compared with Medicare (OR=0.895, P <0.093) and those from Shelby County compared with other counties (OR=0.703, P <0.0001).

Our findings indicate that worsening glaucoma severity was associated with higher poverty rates in our patient population. However, isolating socioeconomic status (SES) as an independent factor influencing the incidence and severity of glaucoma remains challenging, given the strong correlation between race and SES.