Paul Y Chua1, Augusto Azuara-Blanco2, William Hulme3, Mark N A Jones3, Mohammed Sohaib Mustafa4, Stephen B Kaye5. 1. The Eye Clinic, Grampian University Hospital, Aberdeen, Scotland, United Kingdom. 2. Centre for Vision and Vascular Science, Queen's University Belfast, Belfast, United Kingdom. Electronic address: a.azuara-blanco@qub.ac.uk. 3. NHS Blood and Transplant, Bristol, United Kingdom. 4. Moorfields Eye Hospital Dubai, Dubai. 5. St. Paul's Eye Unit, Royal Liverpool Hospital, Liverpool, United Kingdom.
Abstract
OBJECTIVE: To investigate the effect of socioeconomic deprivation on cornea graft survival in the United Kingdom. DESIGN: Retrospective cohort study. PARTICIPANTS: All the recipients (n = 13,644) undergoing their first penetrating keratoplasty (PK) registered on the United Kingdom Transplant Registry between April 1999 and March 2011 were included. METHODS: Data of patients' demographic details, indications, graft size, corneal vascularization, surgical complication, rejection episodes, and postoperative medication were collected at the time of surgery and 1, 2, and 5 years postoperatively. Patients with endophthalmitis were excluded from the study. Patients' home postcodes were used to determine the socioeconomic status using a well-validated deprivation index in the United Kingdom: A Classification of Residential Neighborhoods (ACORN). Kaplan-Meier survival and Cox proportional hazards regression were used to evaluate the influence of ACORN categories on 5-year graft survival, and the Bonferroni method was used to adjust for multiple comparisons. MAIN OUTCOME MEASURES: Patients' socioeconomic deprivation status and corneal graft failure. RESULTS: A total of 13,644 patients received their first PK during the study periods. A total of 1685 patients (13.36%) were lost to follow-up, leaving 11,821 patients (86.64%) for analysis. A total of 138 of the 11,821 patients (1.17%) developed endophthalmitis. The risk of graft failure within 5 years for the patients classified as hard-pressed was 1.3 times that of the least deprived (hazard ratio, 1.3; 95% confidence interval, 1.1-1.5; P = 0.003) after adjusting for confounding factors and indications. There were no statistically significant differences between the causes of graft failure and the level of deprivation (P = 0.14). CONCLUSIONS: Patients classified as hard-pressed had an increased risk of graft failure within 5 years compared with the least deprived patients.
OBJECTIVE: To investigate the effect of socioeconomic deprivation on cornea graft survival in the United Kingdom. DESIGN: Retrospective cohort study. PARTICIPANTS: All the recipients (n = 13,644) undergoing their first penetrating keratoplasty (PK) registered on the United Kingdom Transplant Registry between April 1999 and March 2011 were included. METHODS: Data of patients' demographic details, indications, graft size, corneal vascularization, surgical complication, rejection episodes, and postoperative medication were collected at the time of surgery and 1, 2, and 5 years postoperatively. Patients with endophthalmitis were excluded from the study. Patients' home postcodes were used to determine the socioeconomic status using a well-validated deprivation index in the United Kingdom: A Classification of Residential Neighborhoods (ACORN). Kaplan-Meier survival and Cox proportional hazards regression were used to evaluate the influence of ACORN categories on 5-year graft survival, and the Bonferroni method was used to adjust for multiple comparisons. MAIN OUTCOME MEASURES: Patients' socioeconomic deprivation status and corneal graft failure. RESULTS: A total of 13,644 patients received their first PK during the study periods. A total of 1685 patients (13.36%) were lost to follow-up, leaving 11,821 patients (86.64%) for analysis. A total of 138 of the 11,821 patients (1.17%) developed endophthalmitis. The risk of graft failure within 5 years for the patients classified as hard-pressed was 1.3 times that of the least deprived (hazard ratio, 1.3; 95% confidence interval, 1.1-1.5; P = 0.003) after adjusting for confounding factors and indications. There were no statistically significant differences between the causes of graft failure and the level of deprivation (P = 0.14). CONCLUSIONS:Patients classified as hard-pressed had an increased risk of graft failure within 5 years compared with the least deprived patients.
Authors: Alastair K Denniston; Aaron Y Lee; Cecilia S Lee; David P Crabb; Clare Bailey; Peck-Lin Lip; Paul Taylor; Maria Pikoula; Esther Cook; Toks Akerele; Richard Antcliff; Christopher Brand; Usha Chakravarthy; Randhir Chavan; Narendra Dhingra; Louise Downey; Haralabos Eleftheriadis; Faruque Ghanchi; Rehna Khan; Vineeth Kumar; Aires Lobo; Andrew Lotery; Geeta Menon; Rajarshi Mukherjee; Helen Palmer; Sudeshna Patra; Bobby Paul; Dawn A Sim; James Stephen Talks; Elizabeth Wilkinson; Adnan Tufail; Catherine A Egan Journal: Br J Ophthalmol Date: 2018-09-29 Impact factor: 4.638
Authors: Michael C Chen; Allen R Kunselman; Christy M Stetter; Sadeer B Hannush; Benjamin W Roberts Journal: PLoS One Date: 2017-10-27 Impact factor: 3.240