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The following is a summary of “Socioeconomic status mediates and modifies racial and ethnic disparities in incisional glaucoma surgical outcomes,” published in the March 2025 issue of American Journal of Ophthalmology by Kitayama et al. 

Researchers conducted a retrospective study to estimate the extent to which socioeconomic status (SES) differences accounted for racial and ethnic disparities in glaucoma surgical outcomes.  

They analyzed data from the entire 2016–2018 California (CA) fee-for-service Medicare population with claims for incisional glaucoma surgery (trabeculectomy, tube shunt, or EX-PRESS shunt). Race and ethnicity were categorized as Non-Latinx White (reference), Black, Latinx, Asian/Pacific Islander (PI), and Other. The SES was classified as low or non-low based on Medicaid dual eligibility. Surgical failure, defined as a claim for revision or reoperation, was the outcome. Total effect (TE) assessed overall racial and ethnic disparities, while controlled direct effect (CDE) measured disparities after setting SES to non-low for all. The proportion eliminated (PE) reflected the disparity reduction with uniform SES. Cox proportional hazards modeling provided hazard ratio estimates for time-to-event analysis.  

The results showed that the final analytical sample included 5,985 unique CA beneficiaries. After setting SES to non-low, the racial and ethnic disparity decreased most for Black individuals (TE: 1.18, 95% CI): 0.99-1.41;  (CDE: 1.01, 95% CI: 080-1.77), followed by Latinx individuals (TE: 1.23, 95% CI: 1.08-1.51; CDE: 1.10, 95% CI: 0.90-1.35), Other race and ethnicity (TE: 1.32, 95% CI: 1.03-1.70; CDE: 1.24, 95% CI: 0.91-1.68), and Asian/PI individuals (TE: 1.18, 95% CI: 1.02-1.36; CDE: 1.21, 95% CI: 0.99-1.47). The PE estimates indicated SES equalization could reduce disparities by up to 96% for Black individuals (PE: 0.96, 95% CI: -0.27-2.19), 54% for Latinx individuals (PE: 0.54, 95% CI: -0.25-1.33), with minimal changes for Other race and ethnicity (PE: 0.24, 95% CI: -0.49-0.97) and Asian/PI individuals (PE: -0.18, 95% CI: -1.11-0.75).  

Investigators concluded that SES significantly mediated racial and ethnic disparities in glaucoma surgical outcomes, with addressing SES differences potentially eliminating 96% of the disparity observed in Black beneficiaries. 

Source: ajo.com/article/S0002-9394(25)00117-5/abstract