Social Determinants of Health and Impact on Screening, Prevalence, and Management of Diabetic Retinopathy in Adults: A Narrative Review

Patel, Dhruva; Ananthakrishnan, Ajaykarthik; Lin, Tyger; Channa, Roomasa; Liu, T. Y. Alvin; Wolf, Risa M.

doi:10.3390/jcm11237120

Cited by 10 publications

(14 citation statements)

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“…4), socioeconomic status, and inadequate medical follow-up, which are established risk factors. 21,[26][27][28][29] Furthermore, poor glycemic control and lack of routine eye examinations are associated with specific ethnic backgrounds. 28 Our study highlights significant disparities in glycemic control from that recommended and also among different ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

Clinically significant macular edema in an underserved population: Association with demographic factors and hemoglobin A1c

Parimi,

Elsner,

Gast

et al. 2024

Optom Vis Sci

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SIGNIFICANCE Suspected clinically significant macular edema (SCSME) from exudates differed among ethnic groups in our underserved population. African American and Asian subjects had higher prevalence than Hispanics and non-Hispanic Caucasians, from the same clinics. Men had higher prevalence than women. Highly elevated blood glucose was frequent and associated with SCSME. PURPOSE We investigated the association between the presence of SCSME from exudates and hemoglobin A1c (HbA1c), as well as demographic factors such as age, sex, and ethnic group. Our population was underserved diabetic patients from the same geographic locations. Ethnic groups were White Hispanic, non-Hispanic Caucasian, African American, and Asian, with a high proportion of underrepresented minorities. METHODS In a diabetic retinopathy screening study at four community clinics in Alameda County, California, nonmydriatic 45° color fundus images were collected from underserved diabetic subjects following the EyePACS imaging protocol. Images were analyzed for SCSME from exudates by two certified graders. Logistic regression assessed the association between SCSME from exudates and age, sex, ethnic group, and HbA1c. RESULTS Of 1997 subjects, 147 (7.36%) had SCSME from exudates. The mean ± standard deviation age was 53.4 ± 10.5 years. The mean ± standard deviation HbA1c level was 8.26 ± 2.04. Logistic regression analysis indicated a significant association between presence of SCSME from exudates and HbA1c levels (p<0.001), sex (p=0.027), and ethnicity (p=0.030). African Americans (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.06 to 2.50; p=0.025) and Asians (OR, 1.63; 95% CI, 1.05 to 2.54; p=0.029) had a higher risk than Hispanics. After adjusting for ethnicity, sex, and age, the odds of developing SCSME from exudates increased by 26.5% with every 1% increase in HbA1c level (OR, 1.26; 95% CI, 1.18 to 1.36; p<0.001). CONCLUSIONS In our underserved population, many diabetic patients had very high HbA1c values. Ethnic background (African American > Asians > Hispanics), sex (male > female), and HbA1c level were strong indicators for identifying who is at increased risk of developing SCSME from exudates.

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Section: Discussionmentioning

confidence: 99%

Clinically significant macular edema in an underserved population: Association with demographic factors and hemoglobin A1c

Parimi,

Elsner,

Gast

et al. 2024

Optom Vis Sci

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“…Numerous studies have examined factors associated with reduced DR screening rates among patients with diabetes . Such factors encompass younger age, minority racial or ethnic group, lower levels of income or education, neighborhood deprivation, and unfavorable housing conditions .…”

Section: Introductionmentioning

confidence: 99%

“…4 Numerous studies have examined factors associated with reduced DR screening rates among patients with diabetes. [5][6][7][8][9][10][11][12][13][14] Such factors encompass younger age, 5 minority racial or ethnic group, 5,11,12 lower levels of income or education, 5 neighborhood deprivation, 7,13 and unfavorable housing conditions. 10,13 While previous research has acknowledged various socioeconomic variables that are associated with lower adherence to DR screening, few studies have delved into patients' perspectives to elucidate the reasons behind this discrepancy.…”

mentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12][13][14] Such factors encompass younger age, 5 minority racial or ethnic group, 5,11,12 lower levels of income or education, 5 neighborhood deprivation, 7,13 and unfavorable housing conditions. 10,13 While previous research has acknowledged various socioeconomic variables that are associated with lower adherence to DR screening, few studies have delved into patients' perspectives to elucidate the reasons behind this discrepancy. 13,14 Studies that analyze the effects of patient-reported factors for eye conditions and social determinants of health (SDOH) are prevalent, but studies focusing on these topics in DR screening are sparse.…”

mentioning

confidence: 99%

“…10,13 While previous research has acknowledged various socioeconomic variables that are associated with lower adherence to DR screening, few studies have delved into patients' perspectives to elucidate the reasons behind this discrepancy. 13,14 Studies that analyze the effects of patient-reported factors for eye conditions and social determinants of health (SDOH) are prevalent, but studies focusing on these topics in DR screening are sparse. [15][16][17][18] The All of Us Research Program, funded and administered by the National Institutes of Health, presents a promising opportunity for investigating these issues.…”

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confidence: 99%

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Social Determinants of Health and Perceived Barriers to Care in Diabetic Retinopathy Screening

Ravindranath,

Bernstein,

Fernandez

et al. 2023

JAMA Ophthalmol

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ImportanceRegular screening for diabetic retinopathy often is crucial for the health of patients with diabetes. However, many factors may be barriers to regular screening and associated with disparities in screening rates.ObjectiveTo evaluate the associations between visiting an eye care practitioner for diabetic retinopathy screening and factors related to overall health and social determinants of health, including socioeconomic status and health care access and utilization.Design, Setting, and ParticipantsThis retrospective cross-sectional study included adults aged 18 years or older with type 2 diabetes who answered survey questions in the All of Us Research Program, a national multicenter cohort of patients contributing electronic health records and survey data, who were enrolled from May 1, 2018, to July 1, 2022.ExposuresThe associations between visiting an eye care practitioner and (1) demographic and socioeconomic factors and (2) responses to the Health Care Access and Utilization, Social Determinants of Health, and Overall Health surveys were investigated using univariable and multivariable logistic regressions.Main Outcome and MeasuresThe primary outcome was whether patients self-reported visiting an eye care practitioner in the past 12 months. The associations between visiting an eye care practitioner and demographic and socioeconomic factors and responses to the Health Care Access and Utilization, Social Determinants of Health, and Overall Health surveys in All of Us were investigated using univariable and multivariable logistic regression.ResultsOf the 11 551 included participants (54.55% cisgender women; mean [SD] age, 64.71 [11.82] years), 7983 (69.11%) self-reported visiting an eye care practitioner in the past year. Individuals who thought practitioner concordance was somewhat or very important were less likely to have seen an eye care practitioner (somewhat important: adjusted odds ratio [AOR], 0.83 [95% CI, 0.74-0.93]; very important: AOR, 0.85 [95% CI, 0.76-0.95]). Compared with financially stable participants, individuals with food or housing insecurity were less likely to visit an eye care practitioner (food insecurity: AOR, 0.75 [95% CI, 0.61-0.91]; housing insecurity: AOR, 0.86 [95% CI, 0.75-0.98]). Individuals who reported fair mental health were less likely to visit an eye care practitioner than were those who reported good mental health (AOR, 0.84; 95% CI, 0.74-0.96).Conclusions and RelevanceThis study found that food insecurity, housing insecurity, mental health concerns, and the perceived importance of practitioner concordance were associated with a lower likelihood of receiving eye care. Such findings highlight the self-reported barriers to seeking care and the importance of taking steps to promote health equity.

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The Relationship Between Health Insurance Status and Diabetic Retinopathy Progression

Guo,

Copado,

Yonamine

et al. 2024

Ophthalmology Science

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Social Determinants of Health and Impact on Screening, Prevalence, and Management of Diabetic Retinopathy in Adults: A Narrative Review

Cited by 10 publications

References 104 publications

Clinically significant macular edema in an underserved population: Association with demographic factors and hemoglobin A1c

Clinically significant macular edema in an underserved population: Association with demographic factors and hemoglobin A1c

Social Determinants of Health and Perceived Barriers to Care in Diabetic Retinopathy Screening

The Relationship Between Health Insurance Status and Diabetic Retinopathy Progression

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