Association Between Social Determinants of Health and Examination-Based Vision Loss vs Self-reported Vision Measures

Abstract

ImportanceRecent evidence suggests that social determinants of health (SDOH) affect vision loss, but it is unclear whether estimated associations differ between clinically evaluated and self-reported vision loss.ObjectiveTo identify associations between SDOH and evaluated vision impairment and to assess whether these associations hold when examining self-reported vision loss.Design, Setting, and ParticipantsThis population-based cross-sectional comparison included participants 12 years and older in the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES), participants of all ages (infants and older) in the 2019 American Community Survey (ACS), and adults 18 years and older in the 2019 Behavioral Risk Factor Surveillance System (BRFSS).ExposuresFive domains of SDOH that are based on Healthy People 2030: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.Main Outcomes and MeasuresPresenting vision impairment of 20/40 or worse in the better-seeing eye (NHANES) and self-reported blindness or serious difficulty seeing, even with glasses (ACS and BRFSS).ResultsOf 3 649 085 included participants, 1 873 893 were female (51.1%) and 2 504 206 were White (64.4%). SDOH across domains of economic stability, educational attainment, health care access and quality, neighborhood and built environment, and social context were significant predictors of poor vision. For example, higher income (poverty to income ratio [NHANES]: OR, 0.91; 95% CI, 0.85-0.98; [ACS]: OR, 0.93; 95% CI, 0.93-0.94; categorical income [BRFSS:<$15 000 reference]: $15 000-$24 999; OR, 0.91; 95% CI, 0.91-0.91; $25 000-$34 999: OR, 0.80; 95% CI, 0.80-0.80; $35 000-$49 999: OR, 0.71; 95% CI, 0.71-0.72; ≥$50 000: OR, 0.49; 95% CI, 0.49-0.49), employment (BRFSS: OR, 0.66; 95% CI, 0.66-0.66; ACS: OR, 0.55; 95% CI, 0.54-0.55), and owning a home (NHANES: OR, 0.85; 95% CI, 0.73-1.00; BRFSS: OR, 0.82; 95% CI, 0.82-0.82; ACS: OR, 0.79; 95% CI, 0.79-0.79) were associated with lower odds of vision loss. The study team identified no differences in the general direction of the associations when using either clinically evaluated or self-reported vision measures.Conclusions and RelevanceThe study team found evidence that associations between SDOH and vision impairment track together when using either clinically evaluated or self-reported vision loss. These findings support the use of self-reported vision data in a surveillance system to track trends in SDOH and vision health outcomes within subnational geographies.

Sociodemographic Characteristics Distinguished From Social Determinants of Health

“…Second, Kemper et al mention that community-level SDOH (eg, the availability of local greenspace and air quality) likely influence vision health and note that we were unable to include such measures in our study . Unfortunately, data sources that include detailed geographic identifiers that would facilitate such important community-level analyses typically lack measures of vision loss.…”

“…The commenters stress the importance of differentiating between social risk factors and sociodemographic characteristics and note that researchers should be careful not to equate social determinants of health (SDOH) with membership in a minoritized racial or ethnic group. For those reasons, our study distinguished between the sociodemographic characteristics, including race and ethnicity, and the SDOH that we included in our analyses. Although we mistakenly referred to race and ethnicity as an SDOH along with other factors in one sentence, in the subsequent methods, results, and discussion sections, we differentiated between SDOH and sociodemographic characteristics, such as race and ethnicity.…”