Socioeconomic and Demographic Disparities in Keratoconus Treatment

Abstract

Purpose: To investigate healthcare disparities associated with keratoconus (KCN) patients receiving treatment (corneal cross-linking [CXL] and keratoplasty), as well as comorbidities associated with KCN.

Design: Retrospective clinical cohort study.

Methods: A total of 3224 patients from the University of Illinois Hospital & Health Sciences System (UI-Health) database from 2020 to 2024 were examined, including 1612 patients with an International Classification of Diseases, Tenth Revision diagnosis of KCN, and 1612 ophthalmology patients as a control group. Multivariable and univariable logistic regression were performed to evaluate the associations 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 were odds ratio of undergoing keratoplasty and CXL, and prevalence of comorbid conditions.

Results: Female individuals received less keratoplasty than male individuals (odds ratio [OR] = 0.55, P < .001). Black individuals received less CXL than White individuals (OR = 0.68, P < .05), as did individuals with Medicaid (OR = 0.27, P < .0001) or no insurance (OR = 0.41, P < .001) compared to those with commercial insurance. Individuals from socially vulnerable neighborhoods received less CXL (OR = 0.56, P < .01) and keratoplasty (OR = 0.66, P < .05). Black female individuals were the most vulnerable, undergoing fewer procedures than White female (OR = 0.58, P < .01) and Black male (OR = 0.65, P < .05) individuals. Black and Hispanic/Latin-X individuals presented with more severe disease (P < .01, P < .0001). Down syndrome was more common (P < .01), and diabetes was less common (P < .0001), in KCN patients.

Conclusions: Significant sociodemographic disparities exist in the treatment of KCN. Although further research is necessary, addressing these disparities is crucial for ensuring equitable access to care.