Social Risk Groups in Patients With Diabetes With Differing Eye Care Utilization and Vision Outcomes

Abstract

Purpose: To evaluate whether latent class analysis on social determinants of health (SDoH) data can identify social risk groups that differ by adverse SDoH and vision outcomes in patients with diabetes.

Methods: This was a prospective cohort study of adults ≥18 years with diabetes who completed a SDoH survey. Latent class analysis was used to cluster patients into social risk groups. The association of social risk group and severity of diabetic retinopathy, history of lapses in diabetic retinopathy care, and visual acuity was evaluated.

Results: A total of 1006 participants were included. The three social risk groups differed by sociodemographic characteristics. The average age was 65, 60, and 54 in Groups 1, 2, and 3 respectively. Most (51%) patients in group 1 were non-Hispanic White, 66% in group 2 were non-Hispanic Black, and 80% in group 3 were Hispanic. Group 1 had the lowest burden of adverse SDoH per person (average 3.6), group 2 had 8.2, and group 3 had 10.5. In general, group 1 lacked diabetic retinopathy knowledge, group 2 had financial insecurity and difficulties with transportation, and group 3 had financial insecurity and did not have health insurance. Social risk group was associated with a history of lapses in diabetic retinopathy care, and presenting with worse vision.

Conclusions and translational relevance: We identified distinct social risk groups among patients seeking care for diabetic retinopathy that differed by social needs, eye care utilization, and vision. Identifying these groups and their specific needs can help guide interventions to effectively address adverse SDoH and improve eye care utilization and vision outcomes among patients with diabetes.

Figure 1.

Heat map of the association between social determinants of health (SDoH) variables on the log odds scale. SDoH variables are grouped by domain (education access and quality, economic stability, social and community context, neighborhood and built environment, health care access and quality). Darker colors indicate stronger associations in the positive (red) or negative (blue) directions. Noncolored cells without a log odds value represent nonstatistically significant (p > 0.05) associations.

Figure 2.

Radar graph displaying the proportion of adverse social determinants of health (SDoH) in each social risk group. Group 1 (green line) has the overall least adverse SDoH burden and group 3 (purple line) has the most. Group 3 has the highest proportion of patients without insurance, without a high school degree, and with financial insecurity. Group 2 (orange line) has financial insecurity and difficulties with transportation to the eye doctor. Group 1 had insurance and financial security, but many lacked knowledge about diabetic retinopathy.