ArticleInternational ophthalmology2026
Residence and insurance inequities in the timeliness of access to first-eye cataract surgery in Eastern China.
Article in International ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo quantify residence and insurance inequities in the timeliness of access to first-eye cataract surgery in Eastern China, using better-eye best-corrected visual acuity (BCVA) at surgical-pathway entry as an electronic health record-derived indicator.
methodsWe conducted a retrospective cohort study of consecutive first-eye cataract surgeries at a tertiary hospital in Yangzhou, China (August 2024-July 2025). Analyses were restricted to local insured residents; non-local and self-pay patients were excluded. The primary outcome was better-eye BCVA (logMAR), defined as the better (lower logMAR) value between the two eyes measured at the admission-registration (pathway-entry) assessment. Adjusted differences were estimated using multivariable linear regression with surgeon fixed effects and heteroskedasticity-consistent (HC3) robust standard errors. Prespecified categorical analyses used multinomial logistic regression.
resultsAmong 1438 eligible patients, bilateral BCVA was measured at pathway entry in 1437 (99.9%). Compared with Urban-Employee patients, adjusted better-eye BCVA was worse in Urban-Resident (0.09 logMAR; 95% CI 0.01-0.17), Rural-Employee (0.11; 0.01-0.21), and Rural-Resident patients (0.17; 0.11-0.24); adjusted marginal means were 0.32, 0.41, 0.43, and 0.49 logMAR, respectively. Rural-Resident patients were less likely to enter in the early category (RRR 0.52; 95% CI 0.39-0.69) and more likely to enter in the late category (RRR 1.76; 95% CI 1.15-2.69).
conclusionResidence and insurance inequities in the timeliness of access to first-eye cataract surgery were evident. Better-eye BCVA at pathway entry is a low-cost, scalable metric that can complement coverage and postoperative outcomes to guide pathway and financing interventions.
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