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Purpose <p>To 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.</p> Methods <p>We 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.</p> Results <p>Among 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).</p> Conclusion <p>Residence 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.</p>

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Residence and insurance inequities in the timeliness of access to first-eye cataract surgery in Eastern China

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月6日

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  • Chen Qin,
  • Jie Zhu,
  • Tian Yang

摘要

Purpose

To 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.

Methods

We 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.

Results

Among 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).

Conclusion

Residence 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.