Social Factors Put Diabetes Patients at Risk for Vision Loss | ASRS 2024

Social factors can have negative impact on whether people with diabetes seek care for their eyes, according to presentation at the American Society of Retina Specialists 2024 meeting in Stockholm.

Cindy X. Cai, M.D.

“Social determinants of health are the conditions that shape daily living,” Cindy X. Cai, M.D., the Jonathan and Marcia Javitt Rising professor of Ophthalmology at Johns Hopkins in Baltimore, said during her presentation. “We have an increasing wealth of evidence suggesting that social determinants of health play a critical role in health outcomes, including in ophthalmology.”

Cai and her colleagues wanted to evaluate the association of social determinants of health (SDoH) with eye care use among people with diabetes.

They used the 2013 -2017 National Health Interview Survey (NHIS), a survey used by the U.S. Department of Health and Human Services to monitor trends in illnesses and disability. Researchers conducted a retrospective analysis of patients 18 years of age and older with diabetes who said they had used eye care services in previous 12 month.

Cai and her colleagues used the KFF framework for social determinants of health and considered economic stability; neighborhood, and physical environment; community and social context; food environment; education; and healthcare system. Addressing these factors can help to improve health, as well as disparities in health and healthcare, according to KFF.

Researchers at Johns Hopkins calculated a score and divided into quartiles, with quartile 4 representing those with the highest burden related to social determinants of health. The outcome assessed was eye care use in the preceding 12 months.

Researchers found that of 20,807 adults with diabetes, 43% had not used eye care in the preceding 12 months, and that greater social determinants of health burden were associated with decreased odds of eye care utilization. Participants in the quartile 4 (the highest quartile of adverse social determinants of health burden) had an estimated 58% lower odds of eye care utilization than those in quartile 1.

Economic stability had the strongest association with eye care use, and underuse of eye care services was associated with all of the social determinants identify by KFF. In the Johns Hopkins study, the negative impact of adverse social determinants on eye care use was similar across race and ethnic groups, and underuse of eye services was similar for patients with type 1 and type 2 diabetes.

“This work emphasizes the interconnectedness of SDoH and their impact on health outcomes. Screening and addressing the impacts of adverse SDoH should consider the multidimensionality of these determinants,” researchers wrote in the published study results in Ophthalmology in June 15, 2023. “Ultimately, addressing adverse SDoH and connecting patients to needed services could be a means by which to improve eye care use among people with diabetes and prevent vision loss.”