Racial variations in treatment for glaucoma and cataract among Medicare recipients

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Abstract
Purpose To identify the location of barriers to treatment for glaucoma and cataract among African-American Medicare beneficiaries. Methods We examined the receipt of eye care in general and care for glaucoma and cataract in particular among black and white Medicare beneficiaries using 1991 Medicare physician claims data. Racial differences in treatment for glaucoma and cataract were examined both for the Medicare population as a whole and for identified eye care users. The results were compared to the expected value of black-white difference based on population prevalence data for each specific condition. Results Thirty percent of black beneficiaries and 45% of white Medicare beneficiaries used eye care services in 1991. After adjusting for the expected difference in prevalence, black beneficiaries were half as likely to be surgically treated for glaucoma compared to white beneficiaries, and 80% as likely for cataract. When the analysis was restricted to those using eye care services, blacks continued to have lower than expected rates of treatment for glaucoma (observed RR=3.2,95% confidence interval=3.1–3.4 vs an expected RR of 4.3, 95% confidence interval=3.5–5.4), but a higher rate of treatment for cataract (RR=1.2, 95% confidence interval=1.2–1.3). Among those with physician-diagnosed glaucoma and cataract, blacks were more likely to undergo surgical treatment for these conditions than whites (RR= 1.5 for glaucoma, 95% confidence interval= 1.4–1.5; RR= 1.2 for cataract, 95% confidence interval= 1.2–1.3). Conclusion Barriers to treatment for glaucoma and cataract among black Medicare beneficiaries involve primarily limitations in access to the eye care system. The undertreatment for glaucoma among black beneficiaries was reduced, but not eliminated, after removing the effect of unequal access to the eye care system.