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Rim, Woo, Park, Kim, and The Epidemiologic Survey Committee in the Korean Ophthalmological Society: Current Status and Future Expectations of Cataract Surgery in Korea: KNHANES IV
Original Article

J Korean Ophthalmol Soc 2014;55(12):1772-1778.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.12.1772

Current Status and Future Expectations of Cataract Surgery in Korea: KNHANES IV

Tyler Hyung Taek Rim, MD1, Young Jae Woo, MD1, Hyun Joo Park, MD1, Sung Soo Kim, MD, PhD1, ; The Epidemiologic Survey Committee in the Korean Ophthalmological Society2

1Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

2The Epidemiologic Survey Committee in the Korean Ophthalmological Society, Seoul, Korea

Address reprint requests to Sung Soo Kim, MD, PhD, Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea, Tel: 82-2-2228-3578, Fax: 82-2-312-0541, E-mail: SEMEKIM@yuhs.ac

Received 10 May 2014       Revised 19 August 2014       Accepted 5 November 2014

Copyright © 2014 The Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To identify socio-demographic factors in cataract surgery in Korea and expect future effect of the bundle of service system.

Methods

We analyzed the number of people undergoing cataract surgery and associated factors such as surgery ratio, region, age, income, and insurance status of 28,980 patients older than 40 years using data from the fifth Korea National Health and Nutrition Examination Survey 2008-2012 (KNHANES).

Results

Among total population in 2012, 47.5% of elderly aged 80 years and older have received cataract surgery. According to region in patients older than 40, Jeollanam-do showed the highest proportion of patients undergoing cataract surgery, at 12%, Daejeon showed the lowest proportion of 3.6%, and Seoul showed 6.8%. Regional analysis was also performed by analyzing the number of cataract patients per ophthalmologist. Jeollanam-do showed the highest with 40,115 patients per ophthalmologist, and Seoul showed the least with 1,094 patients per ophthalmologist. The sociodemographic factors such as education or income, were not associated with cataract surgery after adjusting for age and regional difference. On the other hand, subjects with medicaid were associated with 1.6-fold (95% confidence interval, 1.3-2.0) higher rate of cataract surgery than subjects with national health insurance.

Conclusions

Regional disparity was found in the cataract surgery rate and surgery rate per an ophthalmologists, whereas sociodemographic factors were not significant in receiving benefits of cataract surgery. Before the amount of bundled payment is changing, down-leveling of quality of care and deepening of disparities among health care provider should be considered.

Keywords: Cataract surgery, KNHANES, Sociodemographic disparities

References

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Figure 1.
Cataract surgery ratio according to age group and year. Among total population in 2012, 47.5% of elderly aged 80 years and older have received cataract surgery.
jkos-55-1772f1.tif
Table 1.
Characteristics of study population (n = 28,980)
Characteristics Number Percentage (%)
Cataract surgery No 26,956 93.0
Yes 2,024 7.0
Age group 40-49 5,353 26.8
50-59 5,288 26.5
60-69 4,856 24.3
70-79 3,633 18.2
80-89 824 4.1
Sex Male 12,319 42.5
Female 16,661 57.5
Household monthly income Lowest quartile 5,822 20.4
2nd quartile 7,221 25.3
3rd quartile 7,802 27.3
Highest quartile 7,727 27.0
Education Elementary school 7,612 26.8
Middle school 3,133 11.0
High school 9,629 33.9
University or higher 8,019 28.2
Occupation Administrator, management, professional 3,392 12.0
Business and financial operations occupations 2,211 7.8
Sales and related occupations 3,531 12.5
Farming, fishing, and forestry occupations 2,511 8.9
Installation, maintenance, and repair occupations/technicians 2,589 9.1
Laborer 2,458 8.7
Unemployed, housewife 11,629 41.1
Spouse With 21,016 84.5
Without 3,853 15.5
Insurance National health insurance 27,860 96.9
Medicaid or medicare/no 904 3.1
Private health insurance Yes 19,683 68.0
No 8,826 30.5
Table 2.
Cataract surgery in different region in Korea (estimated total population = 22,183,206)
Region % (95% CI) Estimated patient Distribution of ophthalmologist* Cataract surgery per ophthalmologist
Seoul† 6.8 (5.8-7.9) 1,511,437 1,382 1,094
Busan 9.3 (7.3-11.3) 2,067,293 322 6,416
Daegu 7.0 (5.0-9.1) 1,561,955 260 5,998
Incheon 6.4 (4.6-8.1) 1,410,532 146 9,684
Gwangju 7.4 (5.5-9.2) 1,630,841 119 13,684
Daejeon 3.6 (2.2-4.9) 794,370 128 6,206
Ulsan 4.6 (2.0-7.3) 1,023,977 57 17,845
Gyeonggi 7.0 (6.0-7.9) 1,550,914 627 2,474
Gangwon 9.6 (6.9-12.2) 2,120,905 79 26,694
Chungbuk 7.9 (6.4-9.3) 1,747,180 71 24,739
Chungnam 10.3 (8.4-12.2) 2,293,218 97 23,615
Chonbuk 10.9 (8.0-13.8) 2,422,921 115 21,112
Chonnam 12.0 (9.2-14.8) 2,656,011 66 40,115
Kyungpook 7.9 (6.3-9.5) 1,762,272 124 14,259
Kyungnam 9.0 (7.3-10.8) 2,002,130 159 12,600
Jeju 5.3 (3.1-7.5) 1,171,801 31 37,925

CI = confidence interval.

* There are 552 missing, added these missing to each region by distribution;

† The capital of South Korea.

Table 3.
Factors associated with cataract surgery - age- and region- adjusted logistic regression and multivariate logistic regression
Socio-demographic factors Univariate OR Multivariate OR 95% CI p-value
Sex Male 1.0 (ref) 1.0 (ref)
Female 1.2 1.1 (1.0-1.2) 0.22
Monthly house income Lowest quartile 1.0 (ref) 1.0 (ref)
2nd quartile 0.9 1.0 (0.8-1.1) 0.70
3rd quartile 0.8 0.9 (0.8-1.1) 0.31
Highest quartile 0.8 1.0 (0.8-1.1) 0.62
Education Elementary school 1.0 (ref) 1.0 (ref)
Middle school 0.9 1.0 (0.8-1.1) 0.59
High school 1.0 1.0 (0.9-1.2) 0.82
University or higher 0.9 0.9 (0.8-1.2) 0.63
Occupation Administrator, management, professional 1.0 (ref) 1.0 (ref)
Business and financial operations occupations 1.1 1.5 (0.9-2.4) 0.09
Sales and related occupations 1.6 0.9 (0.6-1.4) 0.73
Farming, fishing, and foresty occupations 0.8 0.8 (0.5-1.1) 0.16
Installation, maintenance, and repair occupations/technicians 1.2 0.9 (0.6-1.4) 0.69
Laborer 0.9 1.0 (0.7-1.5) 0.90
Unemployed, housewife 0.7 1.1 (0.8-1.6) 0.44
Spouse With 1.0 (ref) 1.0 (ref)
Without 1.1 1.0 (0.8-1.1) 0.49
Insurance National health insurance 1.0 (ref) 1.0 (ref)
Medicaid or medicare 1.8 1.6 (1.3-2.0) <0.05
Private health insurance Yes 1.0 (ref) 1.0 (ref)

OR = odds ratio; CI = confidence interval; Ref = reference group.

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