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An analysis of the Ontario Health WTIS database suggests the presence of systematic sex-based differences could be affecting the timeliness of ophthalmic surgery for women.
A recent population-based study investigating the demographic trends of patients undergoing ophthalmic surgery observed consistently longer wait times for women than men, across all procedure types, priority levels, and geographic regions.1
The analysis, utilizing 2010 - 2021 cohort data from the Ontario Health Wait Times Information System (WTIS) database, indicated the presence of systemic sex-based differences could be affecting the timeliness of ophthalmic surgery for women.
“The most striking finding of this study is that there are sex-based differences in surgical wait times, where men have shorter wait times compared with women across ophthalmic subspecialties, geographic regions, and levels of priority,” wrote the investigative team, led by Tina Felfeli, MD, from the department of ophthalmology and vision sciences at the University of Toronto. “Although the difference in wait time might seem modest in terms of absolute difference when compared with the mean wait times, it is important to consider the cumulative impact of these differences on patients and the healthcare system as a whole.”
Increasing demand for ophthalmic surgeries has led to significant pressures put on the healthcare system while growing wait times could burden patients with significant emotional distress and worsen outcomes by prolonging untreated conditions. As a result, wait times serve as a population metric of healthcare delivery that could implicate both individual patients and the entire healthcare system.2 To achieve healthcare equity, Felfeli and colleagues noted it is necessary to detect disparities and their magnitude, as well as understand their case.
For the current analysis, the investigative team analyzed the demographic trends of ophthalmic case volumes and wait times in Ontario, Canada using the WTIS database from January 2010 - December 2021. Each case is assigned a priority level by the surgeon according to WTIS guidelines, ranging from level 1 emergent cases to high, medium, and low priority. The WTIS additionally defined wait time as the number of days from the surgeon and the patient’s joint decision to operate to the time of the surgery for 6 ophthalmic subspecialty procedures.
Investigators looked to summarize demographic shifts over the decade while stratifying by geographic region, priority level, and procedure type. In addition, the team looked for any notable differences in patient demographics, focusing on sex-based differences in wait times. Cohort characteristics were stratified by ophthalmic procedure type, priority level, geographic region, year, age, and sex, and reported descriptively.
During the study period, an average of 83,783 women and 65,555 men underwent ophthalmic surgery annually in Ontario. Women underwent more eye surgeries than men across all ophthalmic specialties, except for retinal procedures (3119 women vs. 3819 men). Overall, the analysis found men experienced consistently shorter wait times compared with women across all surgeries, with an average of 4.9 days shorter wait over the study period (P <.001).
Specifically, oculoplastic and corneal surgeries had the greatest difference in wait times between men and women, while glaucoma and cataract surgery had the smallest difference. When stratified by both priority level and geographic region, the analysis showed women continued to have longer wait times. Moreover, the average age at the time of eye surgery has been increasing at a rate of 0.02 years/year (95% CI, 0.00 - 0.05) over the past decade for all ophthalmic specialties.
Women on the wait list for eye surgery were 0.6 years older than men from 2010 - 2021 (P <.001). Most procedures have experienced a slight decrease in the difference in age between men and women over the last decade, but have increased with increasing levels of surgical priority, according to investigators. Data showed women are 2.6 years older than men for high-priority surgery (P <.001) and 0.4 years older for low-priority surgery (P <.001).
Felfeli and colleagues noted that disparities in wait times existed prior to the COVID-19 pandemic, but recent data has shown a gradual worsening over time, particularly during the pandemic period. In addition, investigators suggested the systemic sex-based biases observed in their findings could be affecting the care of women or other groups in other ways that are not currently measured.
“Further research should be conducted to investigate the institutional-level and patient-level covariates that may be contributing to the disparities discovered in this study, in addition to other possible inequities as well as the impact they may have on health outcomes,” investigators wrote.