Racial differences in glaucoma care: the longitudinal pattern of care.
OBJECTIVE
To examine if racial differences exist in longitudinal care patterns for Medicare beneficiaries with glaucoma.


METHODS
We analyzed national longitudinal Medicare claims data from January 1, 1991, through December 31, 1999 in 21 644 Medicare beneficiaries linked to the National Long-Term Care Survey. Logistic regression was used to predict whether a person underwent an eye examination or eye surgery during the year, and negative binomial regression was used to predict the number of eye examinations and surgical procedures for glaucoma per year. Annual use of eye examinations was nearly identical for black persons (1.85 per year) and white persons (1.89 per year), whereas surgery rates were higher among blacks (0.15) than whites (0.08, P<.001).


RESULTS
Blacks were more likely than whites to have glaucoma diagnosed, but rates among whites were higher than in prior population-based studies. When we controlled for other factors, blacks were not significantly less likely to undergo eye examination during the year; however, blacks were 78% more likely to undergo surgery (P < .001) and had 76% higher rates of surgical procedures (P < .001).


CONCLUSIONS
No systematic pattern was found of underuse among blacks relative to whites after glaucoma diagnosis. Higher rates of surgery among blacks may indicate delayed onset of care and/or greater disease severity.
Ostermann
Jan
J
Center for Health Policy, Law, and Management, Duke University Medical School, Durham, NC 27708, USA.
Sloan
Frank A
FA
Herndon
Leon
L
Lee
Paul P
PP
D044383:Black People / Q000706:statistics & numerical data*; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003941:Diagnostic Techniques, Ophthalmological / Q000706:statistics & numerical data; D005901:Glaucoma / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D006278:Medicare / Q000706:statistics & numerical data*; D010808:Physical Examination; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American