OLD-AGE AND RACE AS DETERMINANTS OF INITIATION OF GLAUCOMA THERAPY

Demographic differences in the prevalence of blindness may be partly d ue to undertreatment of susceptible population subgroups. The authors examined the relation of age, race, and other demographic characterist ics with initiation of treatment for glaucoma and compared treatment r ates with expected rates based on known disease prevalence. Data were from Medicaid enrollees aged 65-99 years in New Jersey between March 1 981 and February 1990. Based on review of all claims for prescription medications and laser and incisional surgery, there were 6,173 cases w ith at least 6 months of documented system eligibility before their in itial treatment for glaucoma. The overall rate of new treatment was 11 .5 cases per 1,000 person-years, and increased throughout the 1980s. T he age-adjusted relative rate of new treatment was 1.58 times higher i n blacks compared with whites; however, this was less than half the re lative rate expected based on estimated relative incidence rates. Simi larly, enrollees aged 70-99 years had only 7% to 27% higher treatment rates than those aged 65-69 years, substantially less than expected. T reatment for glaucoma was also less likely to be initiated in nursing home residents, compared with those living in the community. Blacks an d the very old are much less likely to have treatment for glaucoma ini tiated than would be predicted based on the magnitude of disease burde n in these populations.