Measures of socioeconomic status and self-reported glaucoma in the U.K. Biobank cohort

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.

Figure 1

Frequency of self-reported glaucoma by age (%±SE). There is a significantly greater rate of glaucoma reported by older participants (P<0.001).

Figure 2

Reported rates of glaucoma by ethnicity (%±SE). The rates of self-reported glaucoma is greatest in Black (P<0.001) and Asian (P=0.009) participants.

Figure 3

Frequency of self-reported glaucoma by annual income (%±SE). The rate of self-reported glaucoma is inversely related to income, and extends across the full range of the income spectrum.

Figure 4

Comparison of Townsend deprivation index between individuals reporting a diagnosis of glaucoma vs those who do not (mean Townsend deprivation index±SE). Participants reporting glaucoma were significantly more likely to have a less-negative Townsend deprivation index score (P<0.001). This indicates that both groups are less deprived than the UK average (index=0, scores>0 indicate relative deprivation), but those reporting a diagnosis of glaucoma were less likely to be as affluent as those without disease.