Association Between Sociodemographic Risk Factors and No-Show Propensity in a Glaucoma Population Before and During Covid-19 Pandemic.

Abstract

Prcis: Greater social vulnerability, younger age, non-white race, Hispanic ethnicity, non-English speaking, Medicaid insurance, and milder glaucoma were associated with higher no-show propensity, which worsened during the Covid-19 pandemic among those subjects who were older and more socially vulnerable.

Purpose: To identify sociodemographic risk factors for higher likelihood to no-show among glaucoma subjects before and during the Covid-19 pandemic using the no-show propensity factor (NSPF), a novel attendance metric, which improves upon no-show percentages by adjusting for number of visits.

Methods: We analyzed de-identified demographic, visit attendance, and social risk factor data (social vulnerability index (SVI) and area deprivation index (ADI) scores) of de-identified glaucoma subjects from the Bascom Palmer Glaucoma Repository, computed NSPF, and categorized scores as low, intermediate, or high by the 75th and 90th percentiles for the pre-pandemic and pandemic periods. We identified predictors of NSPF scores using univariable, multivariable, and logistic regression analyses.

Results: Of 15,342 subjects, 11,474, 2,238, and 1,630 subjects had low, intermediate, and high NSPF scores respectively with no-show rates of 9.5%, 39.2%, and 57.8% respectively. Age (β=-0.039 per decade, P<0.001), Black race (β=0.152, P<0.001), Hispanic ethnicity (β=0.115, P<0.001), Medicaid (β=0.073, P<0.001), Spanish primary language (β=0.076, P<0.001), SVI scores (β=0.047 per 25% increase, P<0.001), ADI ranking (β=0.057 for highest quartile, P<0.001), and baseline moderate (β=-0.046, P<0.001) or severe (β=-0.077, P<0.001) glaucomatous disease were significant predictors of NSPF. Older age (odds ratio (OR) 1.15 per decade, P<0.001), higher overall SVI (OR 1.09 per 25% increase, P<0.001), Medicare/Tricare insurance (OR 1.13, P=0.044), and non-English/Spanish primary language (OR 1.43, P=0.020) were associated with worsening NSPF during the pandemic.

Conclusion: Younger age, non-white race, Hispanic ethnicity, non-English primary language, Medicaid, milder glaucoma, and residence in vulnerable areas are risk factors for greater propensity to no-show.