The Effect of Socioeconomic Deprivation on Corneal Graft Survival in the United Kingdom

• Published in: Ophthalmology (Rochester, Minn.) Vol. 120; no. 12; pp. 2436 - 2441
• Main Authors: Chua, Paul Y., MBChB, Azuara-Blanco, Augusto, PhD, Hulme, William, MSc, Jones, Mark N.A., MSc, Mustafa, Mohammed Sohaib, MD, Kaye, Stephen B., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2013
• Subjects: Corneal Diseases - physiopathology; Corneal Diseases - surgery; Female; Graft Rejection - physiopathology; Graft Survival - physiology; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Ophthalmology; Registries; Retrospective Studies; Risk Factors; Social Class; Treatment Outcome; United Kingdom
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2013.07.050

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. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.