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Multicenter Study
. 2024 Oct 1;142(10):961-970.
doi: 10.1001/jamaophthalmol.2024.3528.

Race, Social Determinants of Health, and the Quality of Diabetic Eye Care

Azraa S Chaudhury  1 , Maryam Ige  1 , Shikha Marwah  2 , Xueqing Zhou  1 , Chris A Andrews  2 , Kunal Kanwar  1 , Charlesnika T Evans  3   4 , Abel N Kho  3 , Joshua D Stein  2 , Paul J Bryar  1 , Dustin D French  1   5   4 ; Sight Outcomes Research Collaborative (SOURCE) Consortium
Collaborators, Affiliations
Multicenter Study

Race, Social Determinants of Health, and the Quality of Diabetic Eye Care

Azraa S Chaudhury et al. JAMA Ophthalmol. .

Abstract

Importance: Besides race, little is known about how other social determinants of health (SDOH) affect quality of diabetic eye care.

Objective: To evaluate the association between multiple SDOH and monitoring for diabetic retinopathy (DR) in accordance with clinical practice guidelines (CPGs).

Design, setting, and participants: This cohort study was conducted in 11 US medical centers and included adult patients (18-75 years old) with diabetes. Patients received care from 2012 to 2023 and had 18 months or more of follow-up.

Exposures: Multiple SDOH and associated factors, including ethnicity, urbanicity of residence, health insurance type, and diabetes type.

Main outcomes and measures: Adjusted odds ratio (aOR) of receiving 1 or more eye-care visits and 1 or more dilated fundus examinations in accordance with CPGs.

Results: The study cohort included 37 397 adults with diabetes: 10 157 Black patients and 27 240 White patients. The mean (SD) age was 58 (11) years for Black patients and 59 (11) years for White patients. Of the Black patients, 6422 (63.2%) were female and 3735 (36.8%) male; of the White patients, 13 120 (48.1) were female and 14 120 (51.8) were male. Compared with those of the same race in urban communities, Black patients (aOR, 0.12; 95% CI, 0.04-0.31) and White patients (aOR, 0.75; 95% CI, 0.62-0.91) with diabetes living in rural communities had 88% and 25% lower odds of having eye-care visits, respectively. Sicker Black and White patients, defined by the Charlson Comorbidity Index, had 4% (aOR, 1.04; 95% CI, 1.02-1.06) and 5% (aOR, 1.05, CI 1.04-1.06) higher odds of having an eye-care visit, respectively. Black patients with preexisting DR had 15% lower odds of visits (aOR, 0.85, CI 0.73-0.99) compared with those without preexisting DR while White patients with preexisting DR had 16% higher odds of eye-care visits (aOR, 1.16; 95% CI, 1.05-1.28). White patients with Medicare (aOR, 0.85; 95% CI, 0.80-0.91) and Medicaid (aOR, 0.81; 95% CI, 0.68-0.96) had lower odds of eye-care visits vs patients with commercial health insurance. Hispanic White patients had 15% lower odds of eye-care visits (aOR, 0.85; 95% CI, 0.74-0.98) vs non-Hispanic White patients. White patients with type 1 diabetes had 17% lower odds of eye-care visits (aOR, 0.83; 95% CI, 0.76-0.90) vs those with type 2 diabetes. Among patients who had eye-care visits, those with preexisting DR (Black: aOR, 1.68; 95% CI, 1.11-2.53; White: aOR, 1.51; 95% CI, 1.16-1.96) were more likely to undergo dilated fundus examinations.

Conclusions and relevance: This study found that certain SDOH affected monitoring for DR similarly for Black and White patients with diabetes while others affected them differently. Patients living in rural communities, Black patients with preexisting DR, and Hispanic White patients were not receiving eye care in accordance with CPGs, which may contribute to worse outcomes.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Chaudhury reported consulting fees from ReNAgade Therapeutics and Precede Biosciences outside the submitted work. Dr Evans reported grants from the National Institutes of Health outside the submitted work. Dr Stein reported grants from Janssen, AbbVie, and Ocular Therapeutix outside the submitted work. No other disclosures were reported.

Comment on

References

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