Studies Underscore Racial, Ethnic Disparities in Ocular Injury, Eye Loss

Racial and ethnic disparities in ocular injury and eye loss were the focus of 2 presentations given during the social justice, diversity, and distribution of oculofacial plastic surgeons in the United States session of the American Society of Ophthalmic Plastic & Reconstructive Surgery 2021 Fall Scientific Symposium.

“Interpersonal violence is a significant public health problem,” explained Norberto Mancera, MD, of the ophthalmology and visual sciences department at the Medical School of Wisconsin in Milwaukee. “On a neighborhood level social and economic vulnerabilities such as poverty, housing insecurity, unemployment, and incarceration increase the risk of interpersonal violence,” he added.

As these social determinants of health (SDOH) lead to racial and ethnic health disparities and are associated with poor outcomes, Mancera and colleagues conducted a retrospective chart review¹ to assess the demographics and clinical characteristics of assault-related orbital fractures.

Health disparities resulting from SDOH are “particularly relevant in racially segregated communities, as segregation has been shown to isolate racial and ethnic minorities into areas characterized by socioeconomic disadvantage, including concentrated poverty,” Mancera said.

Researchers assessed assault-related orbital fracture data from a Level I urban trauma center, the only in the region, from 2013 to 2019 in Milwaukee, Wisconsin. They then aggregated cases of orbital assault to Census tract data. “The Milwaukee metro area is considered hyper segregated because it rates high on multiple dimensions of segregation,” Mancera noted.

Of the 410 included patients with orbital fractures attributed to assault, 310 were male (76%) and the majority were younger than age 40. Fifty-two percent of fractures were isolated to a single orbital wall and 46% of patients were found to have concurrent substance use.

Analyses revealed:

• For the 326 (80%) patients residing in Milwaukee County at the time of injury, majority Black neighborhoods (ie, neighborhoods with >50% Black residents) have a 5.3 times higher incident rate of orbital assault compared with majority White neighborhoods.
• Majority Hispanic and majority other-type (a combination of racial ethnic groups other than non-Hispanic White) neighborhoods have a 3.35 and 3.94 times higher incident rate, respectively, compared with majority White neighborhoods.
• The elevated incident rates were significantly attenuated across all minority neighborhoods after accounting for neighborhood factors of poverty, unemployment, and education level.
• Low education had the strongest association with the incidence of assault-related orbital fractures, followed by poverty.

Overall, the results showed segregated minority neighborhoods suffer a substantially higher rate of violent orbital trauma, and neighborhood poverty, unemployment, and low education play significant roles in the rates observed. Moving forward, focusing energy on improving education access in these areas could help reduce disparities, Mancera said.

“Hyper segregation may uniquely affect the shape and the social-physical characteristics of the neighborhoods and thus, our findings may not be generalizable to areas that are not considered hyper segregated,” he concluded.

A separate analysis² presented at the session explored social and medical factors associated with eye loss. Alison Chan, a fourth-year medical student at the University of California San Diego, outlined findings of a case-controlled study using data from the National Institutes of Health All of Us database. This database, initiated in 2018, focuses on enrolling traditionally underrepresented minorities; Hispanic or Latino and African American populations represent 17% to 20% of the population.

“While most of us are probably familiar with the medical risk factors for the loss of an eye, such as ocular trauma or tumor, less is known about the sociodemographic risk factors, especially at the nationwide scale,” Chan explained.

Using procedure and diagnostic codes, the researchers identified cases of eye loss (n = 231) recorded within the database. They then matched controls (n = 924) to 2020 Census data. Patients who lost an eye had a mean age of around 60, and the majority of individuals were male (54.1%); 87 (37.7%) individuals identified as Black and 49 (21.2%) identified as Hispanic or Latino.

Researchers determined that factors associated with eye loss included annual household income less than $25,000, housing instability, and unemployment.

Multivariable analyses revealed ocular tumor, ocular trauma, glaucoma, ocular infection, and diabetes were also significantly associated with loss of eye. Prevalence of eye loss was highest in New York, California, Illinois, Pennsylvania, and Florida.

“With regards to social risk factors, we were able to identify a key racial disparity and we found that the risk of eye loss is higher for African Americans (odds ratio [OR] 3.53; 95% CI, 1.94-6.42; P < .001), even after adjusting for covariates such as education and income level as well as medical risk factors,” Chan said.

State-funded Medicaid insurance was also associated with greater eye loss risk (OR, 4.21; 95% CI, 2.20-8.18; P < .001).

Results underscore the need for public health interventions to improve access to care and prevent adverse outcomes when it comes to eye loss, researchers concluded.

References

1. Mancera N, Do DP, Griepentrog G, and Esmaili N. Assault-related orbital trauma at an urban level I trauma center: clinical features, racial disparity, and association with neighborhood-level social determinants. ASOPRS Fall Scientific Symposium; November 11-12, 2021; New Orleans, LA. Accessed November 12, 2021. https://asoprsfall.virtualbyvario.com/wp-content/uploads/2021/10/ASOPRS_2021_fall_syllabus_FINAL.pdf

2. Chan A, Radha-Saseendrakumar B, Ozzello DJ, et al. Social and medical factors associated with loss of eye using the NIH all of us database. ASOPRS Fall Scientific Symposium; November 11-12, 2021; New Orleans, LA. Accessed November 12, 2021. https://asoprsfall.virtualbyvario.com/wp-content/uploads/2021/10/ASOPRS_2021_fall_syllabus_FINAL.pdf