Background/Purpose:

Autoimmune disease like systemic lupus erythematous and rheumatoid arthritis are influenced by health care disparities due to race, income, sex and age. Uveitis is a frequent association with rheumatic diseases including ankylosing spondylitis, Behçet’s disease, and juvenile idiopathic arthritis. There is lack of national data regarding how health care disparities influence uveitis. The primary aim of our study is to compare the effect of race, income and insurance status in patients with infectious and non-infectious uveitis.

Methods:

We used the National Inpatient Sample (NIS) for the years 2002-2013. We used ICD-9 codes to identify infectious, noninfectious uveitis cases and ocular complications. We collected information on patient’s age, sex, race, income quartile of median household income for patients’ zip code and payer status. A multivariate logistic regression model was run to predict odds of developing infectious uveitis, non-infectious uveitis and ocular complications, adjusted for age, sex, race, income quartile of median household income for patient’s zip code and payer status. To assess the effect of income irrespective of race, we ran a logistic regression model, excluding African Americans. Statistical analysis was done using SAS version 9.4.

Results:

There were a total of 94,143,978 discharges, which included 15,296 total cases of uveitis, 4,538 cases of infectious uveitis and 10,758 cases of non-infectious uveitis. For a multivariate model odds of African Americans having infectious uveitis are five times: (OR = 5.37, 95% CI: 4.95-5.82) and having non-infectious uveitis are one and half times as compared to Caucasians: (OR = 1.43, 95% CI: 1.35-1.52). Odds of Medicare (OR = 2.21, 95% CI= 1.35-3.62) and Medicaid (OR = 1.7, 95% CI = 1.04-2.85) patients having complications from infectious uveitis are double and 1.7 times as compared to those with private insurance. Odds of Medicare (OR = 2.01, 95% CI= 1.46-2.71) and Medicaid (OR = 2.18, 95% CI = 1.51-3.16) patients having complications from non-infectious uveitis are double as compared to those with private insurance.

After excluding African Americans, patients with median household income for patient’s zip code of $ < 38,999 have 1.5 times odds of having infectious uveitis: (OR=1.54, 95% CI=1.38-1.71), as compared to those with median household income > $63,000. Medicare patients have 1.6 times the odds (OR = 1.6, 95% CI= 0.83-3.06) and Medicaid patients double (OR = 2.05, 95% CI = 1.05-4) the odds having ocular complications from infectious uveitis. And Medicare patients have 1.7 times the odds (OR = 1.7, 95% CI= 1.21-2.46) and Medicaid patients double (OR = 2.35, 95% CI = 1.54-3.58) the odds having ocular complications from non-infectious uveitis as compared to those with private insurance.

Conclusion:

African Americans have higher odds of developing infectious and non-infectious uveitis. Medicare and Medicaid patient have higher odds of developing complications from infectious and non-infectious uveitis. Uveitis should be added to the list of immune-mediated diseases which are affected by health care disparities. These disparities cannot be completely explained on the basis of racial or genetic factors.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/health-care-disparities-for-infectious-and-non-infectious-uveitis-in-the-us/