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Tseng VL, Kitayama K, Yu F, Pan D, Coleman AL. Social Vulnerability, Prevalence of Glaucoma, and Incidence of Glaucoma Surgery in the California Medicare Population. Ophthalmol Glaucoma 2023; 6:616-625. [PMID: 37211091 DOI: 10.1016/j.ogla.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/02/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE To examine associations of Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) scores with prevalence of glaucoma and incidence of glaucoma surgery in 2019 California Medicare beneficiaries. DESIGN Retrospective cross-sectional study. PARTICIPANTS 2019 California Medicare beneficiaries ≥ 65 years old with part A and part B coverage. METHODS The exposure of interest was SVI score, which was assessed overall and by themes. Outcomes included prevalence of glaucoma in the study population and incidence of glaucoma surgery in beneficiaries with glaucoma. Logistic regression modeling was performed to assess associations between quartiles of each type of SVI score, prevalence of glaucoma, and incidence of glaucoma surgery, controlling for age, sex, race/ethnicity, Charlson Comorbidity Index score, pseudophakia, and age-related macular degeneration. MAIN OUTCOME MEASURES Prevalence of any glaucoma, primary open angle glaucoma (POAG), secondary open angle glaucoma (SOAG), and angle closure glaucoma in all beneficiaries. Incidence of any glaucoma surgery, trabeculectomy, tube shunt, minimally invasive glaucoma surgery (MIGS), and cyclophotocoagulation (CPC) in beneficiaries with glaucoma. RESULTS Of 5 725 245 beneficiaries in the total study population, there were 215 814 (3.8%) with any glaucoma, and of those with glaucoma, 10 135/215 814 (4.7%) underwent glaucoma surgery. In adjusted analyses for overall SVI score, where higher levels of SVI refer to higher levels of social vulnerability, there were decreased odds of any glaucoma (adjusted odds ratio [aOR] = 0.83; 95% confidence interval [CI] = 0.82, 0.84 for Q4 vs. Q1), POAG (aOR = 0.85; 95% CI = 0.84, 0.87 for Q4 vs. Q1), and SOAG (aOR = 0.59; 95% CI = 0.55, 0.63 for Q4 vs. Q1) in higher (Q4) vs. lower (Q1) SVI quartile. There were increased odds of any glaucoma surgery (aOR = 1.19; 95% CI = 1.12, 1.26 for Q4 vs. Q1), MIGS (aOR = 1.24; 95% CI = 1.15, 1.33 for Q4 vs. Q1), and CPC (aOR = 1.49; 95% CI = 1.29, 1.76 for Q4 vs. Q1) for higher (Q4) vs. lower (Q1) SVI quartile. CONCLUSIONS In the 2019 California Medicare population, there were variable associations between SVI score, prevalence of glaucoma, and incidence of glaucoma surgery. Further investigation is needed to understand the role of social, economic, and demographic factors in glaucoma care on the individual and structural levels. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Victoria L Tseng
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Ken Kitayama
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Fei Yu
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Deyu Pan
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Anne L Coleman
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
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Recchioni A, Makanvand M, Poonit N, Wallace GR, Bartington S, Bloss W, Rauz S. The impact of the first United Kingdom COVID-19 lockdown on environmental air pollution, digital display device use and ocular surface disease symptomatology amongst shielding patients. Sci Rep 2022; 12:20820. [PMID: 36460705 PMCID: PMC9716517 DOI: 10.1038/s41598-022-24650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
Worldwide lockdown reduced air pollution during the first phase of the COVID-19 pandemic. The relationship between exposure to ambient air pollution, digital display device use and dry eye symptoms amongst patients with severe ocular surface disease (OSD) were considered. Symptoms and air pollutant concentrations for three different time periods (pre, during and post COVID-19 lockdown) were analysed in 35 OSD patients who achieved an immunosuppression risk-stratification score > 3 fulfilling the UK Government criteria for 12-week shielding. OSDI symptoms questionnaire, residential postcode air pollution data obtained from the Defra Automated Urban and Rural monitoring network for concentrations of nitrogen dioxide (NO2), nitrogen oxides (NOx), particulate matter (PM) with diameters below 10 µm and 2.5 µm, and English Indices of Deprivation were analysed. Significant reductions in NO2 and NOx concentrations were observed between pre- and during-lockdown periods, followed by a reversal in the post-lockdown period. Changes were linked to the Living Environment outdoor decile. A 12% increase (p = 0.381) in symptomatology during-lockdown was observed that reversed post-lockdown by 19% (p = 0.144). OSDI scores were significantly correlated with hours spent on digital devices (r2 = 0.243) but not with air pollutant concentrations. Lockdown measures reduced ambient air pollutants whilst OSD symptomatology persisted. Environmental factors such as increased time indoors and use of bluescreen digital devices may have partly played a role.
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Affiliation(s)
- Alberto Recchioni
- grid.6572.60000 0004 1936 7486Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK ,grid.6572.60000 0004 1936 7486Academic Unit of Ophthalmology, Birmingham and Midland Eye Centre, Birmingham, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Dudley Road, Birmingham, UK ,grid.7273.10000 0004 0376 4727Optometry and Vision Sciences Group, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Maryam Makanvand
- grid.6572.60000 0004 1936 7486School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Natraj Poonit
- grid.6572.60000 0004 1936 7486Academic Unit of Ophthalmology, Birmingham and Midland Eye Centre, Birmingham, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Dudley Road, Birmingham, UK
| | - Graham R. Wallace
- grid.6572.60000 0004 1936 7486Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Suzanne Bartington
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - William Bloss
- grid.6572.60000 0004 1936 7486School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Saaeha Rauz
- grid.6572.60000 0004 1936 7486Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK ,grid.6572.60000 0004 1936 7486Academic Unit of Ophthalmology, Birmingham and Midland Eye Centre, Birmingham, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Dudley Road, Birmingham, UK
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Saxby E, Cheng K, O'Connell N, Sanders R, Agarwal PK. Is there an association of socioeconomic deprivation with acute primary angle closure? Eye (Lond) 2022; 36:1246-1252. [PMID: 34117395 PMCID: PMC8193016 DOI: 10.1038/s41433-021-01615-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Socioeconomic deprivation is known to increase the risk of late presentation of many diseases. This is the largest study in United Kingdom investigating the relationship between socioeconomic deprivation and acute primary angle closure (APAC). METHODS A retrospective review of case notes was conducted of 718 consecutive patients who underwent laser peripheral iridotomy (LPI) in Edinburgh (Princess Alexandra Eye Pavilion) and Fife (Queen Margaret Hospital) between 2015 and 2019. Baseline demographics including sex, age, ethnicity, pre-existing diabetes, use of anti-depressants, and family history of glaucoma were collected. Deprivation was scored using the Scottish Index of Multiple Deprivation (SIMD) Index 2020v2. A lower rank and decile indicate higher degrees of deprivation. We investigated differences in characteristics between patients who were referred routinely versus patients who referred as APAC. RESULTS The SIMD rank and deciles were consistently lower in patients who were referred urgently with APAC in both centres (P = <0.05) when compared to those referred routinely for LPI. On univariate and multivariate logistic regression, the presentation of APAC is negatively associated with SIMD Decile (OR = -0.101, 95% CI -0.178 to -0.026, P = 0.008) and family history of glaucoma (OR = -1.010, 95% CI -1.670 to -0.426, P = 0.001), and positively associated with age (OR = 0.029, 95% CI 0.009-0.049, P = 0.004). CONCLUSIONS Socioeconomic deprivation is an important risk factors for patients presenting with APAC. Socioeconomic deprivation should be incorporated into the design of glaucoma services and considered when triaging patients for prophylactic and therapeutic LPI and cataract surgery.
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Affiliation(s)
| | | | - Niamh O'Connell
- Ophthalmology Department, Queen Margaret Hospital, Dunfermline, Fife, UK
| | - Roshini Sanders
- Ophthalmology Department, Queen Margaret Hospital, Dunfermline, Fife, UK
- University of Edinburgh, Edinburgh, UK
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Alvarez-Ramos P, Jimenez-Carmona S, Alemany-Marquez P, Cordoba-Doña JA, Aguilar-Diosdado M. Socioeconomic deprivation and development of diabetic retinopathy in patients with type 1 diabetes mellitus. BMJ Open Diabetes Res Care 2020; 8:e001387. [PMID: 33177040 PMCID: PMC7661358 DOI: 10.1136/bmjdrc-2020-001387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/24/2020] [Accepted: 09/05/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Very little is known about the influence of socioeconomic status on type 1 diabetes mellitus (T1DM) complications. Our aim was to determine whether socioeconomic level is a risk factor for the development of diabetic retinopathy (DR) in patients with T1DM. RESEARCH DESIGN AND METHODS A cohort of 150 patients with T1DM were studied prospectively over 9 years. Socioeconomic status was assessed using a neighborhood-level measure based on an index of deprivation. The contribution of other variables such as hypertension, dyslipidemia, diabetic nephropathy and smoking habit was evaluated. Cox proportional hazards models were used to quantify the associations. RESULTS The incidence of DR was 21.6 cases per 1000 patient-years. Multivariable analyses showed that for each percentage point increase in glycated hemoglobin (HbA1c), the risk of developing DR increased by 58% (HR 1.58, 95% CI 1.19 to 2.10).Patients with T1DM onset >18 years of age and resident in areas of lower socioeconomic levels presented with almost triple the risk of developing DR (HR 2.95, 95% CI 1.08 to 8.00) compared with those with onset <18 years of age and resident in less deprived areas. We did not find significant relationships with other variables studied such as hypertension, dyslipidemia, diabetic nephropathy and smoking habit. CONCLUSIONS Low socioeconomic level is a risk factor, independent of glycemic control, in the development of DR in patients with T1DM when the onset of diabetes is in adulthood. This finding indicates that socioeconomic status and age of onset need to be considered in population screening for DR in patients with T1DM.
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Affiliation(s)
- Pablo Alvarez-Ramos
- Ophtalmology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Soledad Jimenez-Carmona
- Ophtalmology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
- Surgery Department, Universidad de Cádiz Facultad de Medicina, Cadiz, Spain
- Research Institute of Biomedicine of Cadiz (INiBICA), Cadiz, Spain
| | - Pedro Alemany-Marquez
- Ophtalmology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
- Surgery Department, Universidad de Cádiz Facultad de Medicina, Cadiz, Spain
- Research Institute of Biomedicine of Cadiz (INiBICA), Cadiz, Spain
| | - Juan Antonio Cordoba-Doña
- Research Institute of Biomedicine of Cadiz (INiBICA), Cadiz, Spain
- Public Health Department, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | - Manuel Aguilar-Diosdado
- Research Institute of Biomedicine of Cadiz (INiBICA), Cadiz, Spain
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, Universidad de Cadiz, Cadiz, Spain
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Denniston AK, Lee AY, Lee CS, Crabb DP, Bailey C, Lip PL, Taylor P, Pikoula M, Cook E, Akerele T, Antcliff R, Brand C, Chakravarthy U, Chavan R, Dhingra N, Downey L, Eleftheriadis H, Ghanchi F, Khan R, Kumar V, Lobo A, Lotery A, Menon G, Mukherjee R, Palmer H, Patra S, Paul B, Sim DA, Talks JS, Wilkinson E, Tufail A, Egan CA. United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services. Br J Ophthalmol 2019; 103:837-843. [PMID: 30269098 PMCID: PMC6582816 DOI: 10.1136/bjophthalmol-2018-312568] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/20/2018] [Accepted: 07/07/2018] [Indexed: 12/21/2022]
Abstract
AIM To assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service. METHODS This is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment. RESULTS 79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58). CONCLUSIONS This large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.
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Affiliation(s)
- Alastair K Denniston
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
| | - Aaron Y Lee
- University of Washington, Seattle, Washington, USA
| | | | | | - Clare Bailey
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Peck-Lin Lip
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Paul Taylor
- Institute of Health Informatics, University College London, London, UK
| | - Maria Pikoula
- Institute of Health Informatics, University College London, London, UK
| | - Esther Cook
- East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Toks Akerele
- Hinchingbrooke Health Care NHS Trust, Hinchingbrooke, UK
| | | | | | | | - Randhir Chavan
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Louise Downey
- Hull and East Yorkshire Hospitals NHS Foundation Trust, Hull, UK
| | | | - Faruque Ghanchi
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rehna Khan
- Calderdale and Huddersfield NHS Foundation Trust, Calderdale, UK
| | - Vineeth Kumar
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Aires Lobo
- Moorfields Eye Centre at Bedford Hospital, Bedford, UK
| | - Andrew Lotery
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Geeta Menon
- Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | | | - Helen Palmer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Bobby Paul
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Dawn A Sim
- Moorfields Eye Centre at Croydon University Hospital, London, UK
| | | | | | - Adnan Tufail
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre at Moorfields Eye Hospitals NHS Foundation Trust, University College London Institute of Ophthalmology, London, UK
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Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives. Surv Ophthalmol 2017; 63:406-436. [PMID: 29100897 DOI: 10.1016/j.survophthal.2017.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.
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Zhang X, Liu Y, Wang W, Chen S, Li F, Huang W, Aung T, Wang N. Why does acute primary angle closure happen? Potential risk factors for acute primary angle closure. Surv Ophthalmol 2017; 62:635-647. [DOI: 10.1016/j.survophthal.2017.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 12/14/2022]
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Hanna KL, Rowe FJ. Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review. Neuroophthalmology 2017; 41:117-136. [PMID: 28512502 DOI: 10.1080/01658107.2017.1279640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 10/19/2022] Open
Abstract
The aim of this study was to report on the health inequalities facing stroke survivors with visual impairments as described in the current literature. A systemic review of the literature was conducted to investigate the potential health inequalities facing stroke survivors with subsequent visual impairments. A quality-of-evidence and risk-of-bias assessment was conducted for each of the included articles using the appropriate tool dependent on the type of article. Only four articles discussed health inequalities affecting stroke survivors with visual impairment specifically. A further 23 articles identified health inequalities after stroke, and 38 reported on health inequalities within the visually impaired UK or Irish population. Stroke survivors with visual impairment face inconsistency in eye care provision nationally, along with variability in the assessment and management of visual disorders. The subgroups identified as most at risk were females; black ethnicity; lower socioeconomic status; older age; and those with lower education attainment. The issue of inconsistent service provision for this population must be addressed in future research. Further research must be conducted in order to firmly establish whether or not stroke survivors are at risk of the aforementioned sociodemographic and economic inequalities.
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Affiliation(s)
- K L Hanna
- Department of Health Services Research, University of Liverpool, Liverpool, United Kingdom
| | - F J Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, United Kingdom
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Vargason CW, Chelnis JG, Barahimi BI, Mawn LA. Socioeconomic Disparities in the Presentation and Treatment of Graves' Disease and Thyroid Eye Disease. Semin Ophthalmol 2016; 31:409-14. [PMID: 27385363 DOI: 10.1080/08820538.2016.1185322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Thyroid eye disease (TED) is an inflammatory, autoimmune orbitopathy with multifactorial etiology. Clinical presentation of TED spans a range from mild surface irritation to vision threatening compressive optic neuropathy. Potential vision loss underscores the importance of understanding genetic and environmental factors influencing the severity of TED presentation. This review will describe the classic risk factors for TED, outline treatments for Graves' disease (GD) and TED, and describe newer evidence of socioeconomic disparities in TED presentation.
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Affiliation(s)
| | - James G Chelnis
- a Vanderbilt Eye Institute, Vanderbilt University , Nashville , TN , USA
| | - Behin I Barahimi
- a Vanderbilt Eye Institute, Vanderbilt University , Nashville , TN , USA
| | - Louise A Mawn
- a Vanderbilt Eye Institute, Vanderbilt University , Nashville , TN , USA
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Hamano T, Li X, Tanito M, Nabika T, Shiwaku K, Sundquist J, Sundquist K. Neighborhood Deprivation and Risk of Age-Related Eye Diseases: A Follow-up Study in Sweden. Ophthalmic Epidemiol 2016; 22:308-20. [PMID: 26395658 DOI: 10.3109/09286586.2015.1056537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine whether there is an association between neighborhood deprivation and age-related eye diseases, particularly macular degeneration, cataract, diabetes-related eye complications, and glaucoma. METHODS The study population comprised a nationwide sample of 2,060,887 men and 2,250,851 women aged 40 years or older living in Sweden who were followed from 1 January 2000 until the first hospitalization/outpatient registration for age-related eye disease during the study period, death, emigration, or the end of the study period on 31 December 2010. Multilevel logistic regression was used to estimate the association between neighborhood deprivation and age-related eye diseases. RESULTS In men, the odds ratio (OR) for age-related eye diseases for those living in high-deprivation neighborhoods compared to those living in low-deprivation neighborhoods remained significant after adjustment for potential confounding factors (macular degeneration, OR 1.08, 95% confidence interval [CI] 1.03-1.12; cataract, OR 1.31, 95% CI 1.26-1.35; diabetes-related eye complications, OR 1.36, 95% CI 1.30-1.43; glaucoma, OR 1.11, 95% CI 1.06-1.15). In women, similar patterns were observed (macular degeneration, OR 1.11, 95% CI 1.07-1.15; cataract, OR 1.36, 95% CI 1.31-1.40; diabetes-related eye complications, OR 1.50, 95% CI 1.42-1.59; glaucoma, OR 1.12, 95% CI 1.08-1.17). CONCLUSION Our results suggest that neighborhood deprivation is associated with age-related eye diseases in both men and women. These results implicate that individual- as well as neighborhood-level factors are important for preventing age-related eye diseases.
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Affiliation(s)
- Tsuyoshi Hamano
- a Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University , Izumo , Japan
| | - Xinjun Li
- b Center for Primary Health Care Research, Lund University , Malmö , Sweden
| | - Masaki Tanito
- c Division of Ophthalmology , Matsue Red Cross Hospital , Matsue , Japan
| | - Toru Nabika
- a Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University , Izumo , Japan .,d Department of Functional Pathology , Shimane University School of Medicine , Izumo , Japan
| | - Kuninori Shiwaku
- a Centre for Community-based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University , Izumo , Japan .,e Department of Environmental and Preventive Medicine , Shimane University School of Medicine , Izumo , Japan , and
| | - Jan Sundquist
- b Center for Primary Health Care Research, Lund University , Malmö , Sweden .,f Stanford Prevention Research Center, Stanford University School of Medicine , Stanford , CA , USA
| | - Kristina Sundquist
- b Center for Primary Health Care Research, Lund University , Malmö , Sweden .,f Stanford Prevention Research Center, Stanford University School of Medicine , Stanford , CA , USA
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Yip JLY, Stafford M. Neighborhood Deprivation and Eye Diseases. Ophthalmic Epidemiol 2015; 22:295-6. [PMID: 26395656 DOI: 10.3109/09286586.2015.1066017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jennifer L Y Yip
- a Institute of Public Health , Department of Public Health and Primary Care , Cambridge , UK and
| | - Mai Stafford
- b UCL, MRC Unit for Lifelong Health and Ageing , London , UK
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12
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Shweikh Y, Ko F, Chan MPY, Patel PJ, Muthy Z, Khaw PT, Yip J, Strouthidis N, Foster PJ. Measures of socioeconomic status and self-reported glaucoma in the U.K. Biobank cohort. Eye (Lond) 2015; 29:1360-7. [PMID: 26315700 PMCID: PMC4815692 DOI: 10.1038/eye.2015.157] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/20/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine ocular, demographic, and socioeconomic associations with self-reported glaucoma in the U.K. Biobank. METHODS Biobank is a study of U.K. residents aged 40-69 years registered with the National Health Service. Data were collected on visual acuity, intraocular pressure (IOP), corneal biomechanics, and questionnaire from 112,690 participants. Relationships between ocular, demographic, and socioeconomic variables with reported diagnosis of glaucoma were examined. RESULTS In all, 1916 (1.7%) people in U.K. Biobank reported glaucoma diagnosis. Participants reporting glaucoma were more likely to be older (mean 61.4 vs. 56.7 years, P<0.001) and male (2.1% vs. 1.4%, P=0.001). The rate of reported glaucoma was significantly higher in Black (3.28%, P<0.001) and Asian (2.14%, P=0.009) participants compared with White participants (1.62%, reference). Cases of reported glaucoma had a higher mean IOP (18 mm Hg both eyes, P<0.001), lower corneal hysteresis (9.96 right eye, 9.89 left eye, P<0.001), and lower visual acuity (0.09 logMAR right eye, 0.08 logMAR left eye, P<0.001) compared with those without (16 mm Hg both eyes, hysteresis 10.67 right eye, 10.63 left eye, 0.03 logMAR right eye, 0.02 logMAR left eye). The mean Townsend deprivation index was -0.72 for those reporting glaucoma and -0.95 for those without (P<0.001), indicating greater relative deprivation in those reporting glaucoma. Multivariable logistic regression showed that people in the lowest income group (<£18,000/year) were significantly more likely to report a diagnosis of glaucoma compared with any other income level (P<0.01). We observed increasing glaucoma risk across the full range of income categories, with highest risk among those of lowest income, and no evidence of a threshold effect. CONCLUSIONS In a large U.K. cohort, individuals reporting glaucoma had more adverse socioeconomic characteristics. Study of the mechanisms explaining these effects may aid our understanding of health inequality and will help inform public health interventions.
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Affiliation(s)
- Y Shweikh
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - F Ko
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - M P Y Chan
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - P J Patel
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Z Muthy
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - P T Khaw
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - J Yip
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - N Strouthidis
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Singapore Eye Research Institute, Singapore, Singapore.,Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia
| | - P J Foster
- Division of Genetics and Epidemiology, NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
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Lane M, Mathewson PA, Sharma HE, Palmer H, Shah P, Nightingale P, Tsaloumas MD, Denniston AK. Social deprivation as a risk factor for late presentation of proliferative diabetic retinopathy. Clin Ophthalmol 2015; 9:347-52. [PMID: 25733801 PMCID: PMC4337620 DOI: 10.2147/opth.s73272] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to determine whether social deprivation is a risk factor for late presentation of patients with proliferative diabetic retinopathy and whether it affects their access to urgent laser treatment. Methods Using a 2:1 case: control design, 102 patients referred to a UK teaching hospital as part of the UK Diabetic Retinopathy National Screening Programme were identified for the period between 1 June 2010 to 1 June 2013. Social deprivation was scored using the Index of Multiple Deprivation 2010. Additional variables considered included age, duration of disease, ethnicity, and HbA1c at time of referral. Results The cases comprised 34 patients referred with proliferative (grade R3) retinopathy with a control group of 68 patients with lower retinopathy grades; two control patients were excluded due to incomplete data. On univariate analysis, R3 retinopathy was associated with higher social deprivation (P<0.001, Mann–Whitney U-test), and with higher HbA1c (11.5% vs 8.4%; P<0.001, Mann–Whitney U-test). Forward stepwise multivariable analysis showed that the association of R3 retinopathy with deprivation was significant even after adjusting for HbA1c (P=0.016). On univariate analysis South Asian ethnicity was also identified as being a risk factor for presentation with R3 retinopathy, but this was no longer significant when HbA1c was adjusted for in a forward stepwise logistic regression analysis. Conclusion In our cohort social deprivation appears to be associated with late presentation of proliferative diabetic retinopathy. Our study supports the need to target these groups to reduce preventable blindness and to identify strategies which overcome barriers to care.
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Affiliation(s)
- Mark Lane
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Priscilla A Mathewson
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hannah E Sharma
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Palmer
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Shah
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ; NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK ; Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Peter Nightingale
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ; Dept of Statistics, Wellcome Trust Clinical Research Facility, Birmingham, UK ; School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marie D Tsaloumas
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alastair K Denniston
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ; Centre for Translational Inflammation Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Yip JLY, Khawaja AP, Chan MPY, Broadway DC, Peto T, Luben R, Hayat S, Bhaniani A, Wareham N, Foster PJ, Khaw KT. Area deprivation and age related macular degeneration in the EPIC-Norfolk Eye Study. Public Health 2015; 129:103-9. [PMID: 25687711 PMCID: PMC4357435 DOI: 10.1016/j.puhe.2014.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 12/04/2022]
Abstract
Objectives To investigate the relationship between area deprivation, individual socio-economic status (SES) and age related macular degeneration (AMD). Study design Cross sectional study nested within a longitudinal cohort study. Methods Data were collected in the EPIC-Norfolk Eye Study by trained nurses, using standardized protocols and lifestyle questionnaires. The English Index of multiple deprivation 2010 (IMD) was derived from participants' postcodes. AMD was identified from standardized grading of fundus photographs. Logistic regression was used to examine associations between IMD, SES and AMD. Results 5344 pairs (62.0% of total 8623) of fundus photographs were of sufficient quality for grading of AMD. Of 5182 participants with complete data, AMD was identified in 653 participants (12.60%, 95%CI = 11.7–13.5%). Multivariable logistic regression showed that people living in the most affluent 5% of areas had nearly half the odds of AMD compared to those living in comparatively more deprived areas (OR = 0.56, 95% CI = 0.36–0.89, P = 0.02), after adjusting for age, sex, education, social class and smoking. Conclusions The authors found that living in the most affluent areas exerted a protective effect on AMD, independently of education and social class. Further investigation into underlying mechanisms will inform potential interventions to reduce health inequalities relating to AMD. The relationship between area deprivation and AMD diagnosed from fundus photographs was examined. Data from 5182 participants from the EPIC-Norfolk Eye study were analyzed. Predominantly early AMD was identified in 653 participants (12.6%). People living in more affluent areas had nearly half the risk of AMD. Results require interpretation with caution due to the healthy population studied.
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Affiliation(s)
- Jennifer L Y Yip
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
| | - Anthony P Khawaja
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Michelle P Y Chan
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - David C Broadway
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Robert Luben
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Shabina Hayat
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Amit Bhaniani
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Kay-Tee Khaw
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
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Knight A, Lindfield R. The relationship between socio-economic status and access to eye health services in the UK: a systematic review. Public Health 2015; 129:94-102. [PMID: 25682906 DOI: 10.1016/j.puhe.2014.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 10/06/2014] [Accepted: 10/20/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Lower socio-economic status has been shown to adversely affect access to general health care. This study aims to determine the existence and nature of an association between socio-economic status and access to eye health services in the UK. STUDY DESIGN Systematic review. METHODS Search terms were run in four databases and reviewed against a pre-agreed set of inclusion and exclusion criteria by two independent reviewers. Quality of studies was assessed according to calculations of statistical significance, size of effect, primary research question and a quality score against an adapted STROBE checklist. RESULTS Good quality studies included in the review most commonly concluded that lower socio-economic groups had less access to eye health services than higher socio-economic groups. However there were a comparable number of studies that concluded that there was no association. This discrepancy was largely attributed to different ways of measuring socio-economic status, access, and types of eye health services, and so studies did not compare the same thing. The evidence base was of low quality, limiting the ability of this review to make definitive conclusions. CONCLUSIONS The review concluded that there is equal and weak evidence of lower socio-economic groups having reduced access to eye health services in the UK, and there being no association. This subject would benefit from further research to improve the quality of the evidence base.
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Affiliation(s)
- A Knight
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - R Lindfield
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Preventing sight loss in older people. A qualitative study exploring barriers to the uptake of regular sight tests of older people living in socially deprived communities in South Wales. Public Health 2015; 129:110-6. [DOI: 10.1016/j.puhe.2014.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 10/10/2014] [Accepted: 10/20/2014] [Indexed: 11/18/2022]
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Sharma HE, Mathewson PA, Lane M, Shah P, Glover N, Palmer H, Haque MS, Denniston AK, Tsaloumas MD. The role of social deprivation in severe neovascular age-related macular degeneration. Br J Ophthalmol 2014; 98:1625-8. [PMID: 24997180 DOI: 10.1136/bjophthalmol-2014-304959] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Advances in therapy have improved outcomes for patients with neovascular age-related macular degeneration (nAMD). Prompt access to treatment is a priority and may be used as a key performance indicator. In this study, we investigate how social deprivation may impact on access to services, treatment and visual impairment registration. METHODS Patients were identified retrospectively through the Certificate of Visual Impairment system for the University Hospitals Birmingham Medical Retina service. The Index of Multiple Deprivation (IMD) 2007 score was calculated for each patient. The impact of deprivation, age, gender and ethnicity on key stages in the care pathway was assessed. RESULTS 120 patients were identified. Patients with greater social deprivation were under-represented, had worse visual acuity at first presentation (correlation of the better-seeing eye with IMD 0.225 (p=0.013)) and had sight-impairment registration earlier (correlation -0.246; p=0.007). Deprivation did not affect time to first appointment, and was not associated with a higher rate of non-attendance. CONCLUSIONS The late presentation and under-representation of patients with greater social deprivation is a serious concern. Our study strongly suggests that this vulnerable group is encountering barriers in accessing treatment in nAMD, and that these occur prior to entry into the Hospital Eye Service.
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Affiliation(s)
- Hannah E Sharma
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Priscilla A Mathewson
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Lane
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Shah
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK Centre for Health and Social Care Improvement, School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Nicholas Glover
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Palmer
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Sayeed Haque
- Department of Primary Care and Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK Academic Unit of Ophthalmology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marie D Tsaloumas
- Ophthalmology Department, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Are ethnicity, social grade, and social deprivation associated with severity of thyroid-associated ophthalmopathy? Ophthalmic Plast Reconstr Surg 2014; 30:241-5. [PMID: 24608325 PMCID: PMC4014637 DOI: 10.1097/iop.0000000000000077] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose: Previous studies have extensively investigated the pathophysiology, genetics, and lifestyle risk factors of thyroid-associated ophthalmopathy (TAO). The aim of this study was to investigate the independent contribution of ethnic origin, social grade, and level of social deprivation to TAO severity in a large, multiethnic, and urban population. Methods: Retrospective case note review of all TAO patients seen at Birmingham and Midland Eye Centre, United Kingdom over a 14-year period. Ethnicity (White, Asian, or Black) was recorded, and residence postcode was used to determine social grade (National Readership Survey classification) and level of social deprivation (Index of Multiple Deprivation 2007). TAO severity was defined by European Group on Graves’ Orbitopathy criteria. Moderate-to-severe: necessity for TAO treatment with oral or intravenous steroid, long-term immunosuppressants, or orbital radiotherapy. Sight-threatening: presence of dysthyroid optic neuropathy (DON) or need for urgent orbital decompression surgery. Multivariable logistic regression was performed to measure the independent influence of ethnicity, social grade, and social deprivation on indicators of severe TAO. Results: Lower social grade was significantly associated with increased odds ratio (OR) of TAO patients having severe TAO, including treatment with oral (OR: 2.3 (95% CI 1.1–5.1) p = 0.03) and intravenous steroid (OR: 2.6 (95% CI 1.0–7.0) p = 0.04) and DON (OR: 4.0 (95% CI 1.2–12.7) p = 0.02), compared with those of highest social grade. Similar results were observed for social deprivation. Ethnicity had no independent association with any measure of TAO severity. Conclusions: In this cohort, lower social grade and higher social deprivation, but not ethnicity, had independent, statistically significant association with more severe TAO. Lower social grade and higher social deprivation, but not ethnic origin, have independent associations with more severe Thyroid-Associated Ophthalmopathy.
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Yip JLY, Luben R, Hayat S, Khawaja AP, Broadway DC, Wareham N, Khaw KT, Foster PJ. Area deprivation, individual socioeconomic status and low vision in the EPIC-Norfolk Eye Study. J Epidemiol Community Health 2013; 68:204-10. [PMID: 24179053 PMCID: PMC4157999 DOI: 10.1136/jech-2013-203265] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Poor vision is associated with lower socioeconomic status, but less is known about its relationship to area deprivation. Methods The European Prospective Investigation into Cancer and Nutrition study Norfolk Eye Study was a cross-sectional study of 8563 participants with completed eye examinations. Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) was measured using standard protocols and low vision (LV) was defined as Snellen equivalent (VA) ≤6/12 in the better eye. Uncorrected refractive error (URE) was defined as improvement of VA by 2 logarithm of the minimum angle of resolution lines with pinhole. The lowest 5% of index of multiple deprivation rank was used to define the most deprived areas. The index of multiple deprivation is a composite measure using routine data from seven domains of deprivation to identify the most disadvantaged areas in England. Logistic regression was used to examine univariable and multivariable associations with LV. Results Ninety-six participants with missing data were excluded, leaving 8467 for analysis (98.9%). The mean age of the study group was 68.7 years (SD=8.1, range=48–92), with 55.1% women. LV was present in 263 participants (3.1%, 95% CI 2.7 to 3.5%). LV was associated with deprivation after adjusting for age, sex, education, social class and cataract surgery (OR=1.7, 95% CI 1.1 to 2.6, p=0.03), but this effect was mitigated by additionally adjusting for URE (OR=1.5, 95% CI 1.0 to 2.4, p=0.09). Conclusions People with LV are more likely to live in the most deprived areas; this association was independent of socioeconomic status and partly mediated by URE. Targeting URE in deprived areas may reduce health inequalities associated with LV.
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Affiliation(s)
- Jennifer L Y Yip
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, , Cambridge, UK
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Yip JLY, Nolan WP, Davaatseren U, Baasankhuu J, Lee PS, Khaw PT, Johnson GJ, Foster PJ, Gilbert CE. Primary Angle Closure Glaucoma in East Asia: Educational Attainment as a Protective Factor. Ophthalmic Epidemiol 2011; 18:217-25. [DOI: 10.3109/09286586.2011.602507] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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