To evaluate associations of socio-demographic factors with pediatric strabismus diagnosis and outcomes.
Retrospective cohort study.
American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) patients with strabismus diagnosed before age of 10 years old.
Multivariable regression models evaluated associations of race and ethnicity, insurance, population density and ophthalmologist ratio with age at strabismus diagnosis, diagnosis of amblyopia, residual amblyopia, and strabismus surgery. Survival analysis evaluated the same predictors of interest with the outcome of time to strabismus surgery.
Age at strabismus diagnosis, rate of amblyopia and residual amblyopia, rate of and time to strabismus surgery.
Median age at diagnosis was 5 years (interquartile range: 3-7) for 106,723 children with esotropia (ET) and 54,454 with exotropia (XT). Amblyopia diagnosis was more likely with Medicaid insurance than commercial insurance (odds ratio [OR] 1.05 for ET; 1.25 for XT; p<0.01), as was residual amblyopia (OR 1.70 for ET; 1.53 for XT; p<0.01). For XT, Black children were more likely to develop residual amblyopia than White children (OR 1.34; p<0.01). Children with Medicaid were more likely to undergo surgery and did so sooner after diagnosis (hazard ratio [HR]: 1.23 for ET; 1.21 for XT; p<0.01) than those with commercial insurance. Compared with White children, Black, Hispanic, and Asian children were less likely to undergo ET surgery and had surgery later (all HR <0.87; p<0.05), and Hispanic and Asian children were less likely to have XT surgery and had surgery later (all HR <0.85; p<0.05). Increasing population density and clinician ratio were associated with lower odds and HR for ET surgery (p<0.01).
Children with strabismus covered by Medicaid insurance had increased odds of amblyopia and underwent strabismus surgery sooner after diagnosis compared with children covered by commercial insurance. After adjusting for insurance status, Black, Hispanic, and Asian children were less likely to receive strabismus surgery with a longer delay between diagnosis and surgery compared with White children.

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