OBJECTIVE To investigate healthcare disparities associated with keratoconus (KCN) patients receiving treatment (collagen cross-linking (CXL) and keratoplasty), as well as comorbidities associated with KCN. DESIGN Retrospective clinical cohort study. SUBJECTS 3224 patients from the UI-Health database from 2020 to 2024, including 1612 patients with an ICD-10 diagnosis of KCN and 1612 ophthalmology patients as a control group. METHODS Multivariable and univariable logistic regression were performed to evaluate association between sociodemographic traits and rates of CXL and keratoplasty. Sociodemographic traits included age, sex, race/ethnicity, insurance status, and neighborhood social vulnerability. Best corrected visual acuity (BCVA) and manifest cylinder were used as indicators of disease impact. Comorbid disease rates were compared to a 1:1 distance-matched control group. MAIN OUTCOME MEASURES Odds ratio of undergoing keratoplasty and CXL, and prevalence of comorbid conditions. RESULTS Females received less keratoplasty than males (OR=0.55, P<0.001). Black individuals received less CXL than White individuals (OR=0.68, P<0.05), as did those with Medicaid (OR=0.27, P<0.0001) or no insurance (OR=0.41, P<0.001) compared to those with commercial insurance. Socially vulnerable neighborhoods received less CXL (OR=0.56, P<0.01) and keratoplasty (OR=0.66, P<0.05). Black females were the most vulnerable, undergoing fewer procedures than White females (OR=0.58, P<0.01) and Black males (OR=0.65, P<0.05). Black and Hispanic/Latin-X individuals presented with more severe disease (P<0.01, P<0.0001). Down Syndrome was more common (P<0.01), and diabetes was less common (P<0.0001) in KCN patients. CONCLUSIONS Significant sociodemographic disparities exist in the treatment of KCN. While further research is necessary, addressing these disparities is crucial for ensuring equitable access to care.

中文翻译：

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圆锥角膜治疗的社会经济和人口差异。


目的 调查与接受治疗 （胶原交联 （CXL） 和角膜移植术 （keratoplasty） 的患者相关的医疗保健差异，以及与 KCN 相关的合并症。设计 回顾性临床队列研究。对象 2020 年至 2024 年来自 UI-Health 数据库的 3224 名患者，包括 1612 名 ICD-10 诊断为 KCN 的患者和 1612 名作为对照组的眼科患者。方法 进行多变量和非变量 logistic 回归以评估社会人口学特征与 CXL 和角膜移植术发生率之间的关联。社会人口学特征包括年龄、性别、种族/民族、保险状况和社区社会脆弱性。最佳矫正视力 （BCVA） 和明显圆柱体用作疾病影响的指标。将合并症发生率与 1：1 距离匹配的对照组进行比较。主要结局指标 接受角膜移植术和 CXL 的比值比，以及合并症的患病率。结果 女性接受的角膜移植术少于男性 （OR=0.55，P<0.001）。黑人个体接受的 CXL 低于白人个体 （OR=0.68， P<0.05），与有商业保险的人相比，有医疗补助 （OR=0.27， P<0.0001） 或没有保险 （OR=0.41， P<0.001） 的人也是如此。社会弱势社区接受的 CXL （OR=0.56，P<0.01） 和角膜移植术 （OR=0.66，P<0.05） 较少。黑人女性最脆弱，接受的手术少于白人女性 （OR=0.58，P<0.01） 和黑人男性 （OR=0.65，P<0.05）。黑人和西班牙裔/拉丁裔 X 个体表现为更严重的疾病 （P<0.01，P<0.0001）。唐氏综合征在 KCN 患者中更常见 （P<0.01），糖尿病较少见 （P<0.0001）。 结论 KCN 的治疗存在显着的社会人口学差异。虽然需要进一步的研究，但解决这些差异对于确保公平获得护理至关重要。