A Key to Improving Outcomes Is Understanding and Addressing Health Care Disparities – Even in Ocular Oncology: 2024 Lorenz Zimmerman Lecture

Background: This manuscript is a publication of the Lorenz Zimmerman Lecture given by Paul J. Bryar, MD, at the American Academy of Ophthalmology – American Association of Ocular Oncologists and Pathologists symposium at the 2024 American Academy of Ophthalmology annual meeting. It is titled: A Key to Improving Outcomes Is Understanding and Addressing Health Care Disparities – Even in Ocular Oncology. Summary: Health care disparities exist in all areas of medicine, with certain groups of people in the same health system having more severe disease and worse outcomes than the general population. This is evident in life expectancy studies that demonstrated significant differences in life expectancy in different ZIP codes within the same city. One of the largest expectancy gaps was in Chicago, with a 30-year difference in life expectancy between affluent neighborhoods versus those with higher Black and socioeconomically disadvantaged areas. Analysis of Chicago area ZIP codes found that neighborhoods with higher rates of poverty and higher minority populations had significantly higher rates of diabetes and diabetic eye disease. The reasons for this disparity are multifactorial and include prior city planning decisions that led to distinct areas with very high concentration of minorities and poverty. These areas are often located adjacent to highways, railways, and industrial areas with higher pollution. These disparities also exist in ocular cancers, with minority populations and economically disadvantaged persons having more advanced stage of cancers compared to the general population in retinoblastoma, uveal melanoma, conjunctival melanoma, and ocular surface neoplasia. In addition to more advanced disease, there is evidence that certain minorities and those with lower socioeconomic status receive different treatments, such as more likelihood to have an enucleation, than others with the exact same stage of disease. Key Messages: From this data, it is clear that the social determinants of health play an important role in severity and outcomes of disease on both the individual and population level. While our health care system must continue to develop better treatments, in many diseases the opportunity for the greatest amount improvement lies in addressing these social determinants. Health care providers and medical educators need to modify our approach to disease to include addressing the social determinants of health to improve both individual and population health outcomes.