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. 2026 Jan 1;45(1):21-28.
doi: 10.1097/ICO.0000000000003766. Epub 2024 Dec 10.

Social Risk Factors Associated With Microbial Keratitis

Madeleine C Lee  1 , Emily L Vogt  1 , Patrice M Hicks  1 , Mercy Pawar  1 , Ming-Chen Lu  1 , Leslie M Niziol  1 , Danielle A Terek  1 , Nambi Nallasamy  1   2 , Farida E Hakim  1 , Maria A Woodward  1   3
Affiliations

Social Risk Factors Associated With Microbial Keratitis

Madeleine C Lee et al. Cornea. .

Abstract

Purpose: The objective of this study was to identify social risk factors (SRFs) that affect microbial keratitis (MK) care using the Penchansky-Thomas (P-T) health care access framework.

Methods: This combined retrospective and prospective cohort study recruited participants with newly diagnosed MK at an academic medical center. Participant demographic information and SRFs were collected using in-person interviews and chart review. SRFs were categorized into P-T framework domains. Primary analysis included proportion of participants reporting SRFs, distribution of reported SRFs, and demographic differences associated with SRFs using descriptive statistics, chi-square, and two-sample t tests. A subgroup analysis for participants who were lost to follow-up (LTFU) was performed.

Results: A total of 100 participants with MK were included in this study. Of the 100 participants, 60.0% reported at least 1 SRF affecting care, 42.0% reported ≥2 SRFs, and 12.0% reported ≥4 SRFs; 40.0% had no SRFs. More SRFs were reported for participants with lower income versus those with higher income ($25,000-$50,000 vs. $51,000-$100,000, P = 0.0363); there were no other demographic differences between groups. The most reported SRF was distance to appointment (45.0%). Accessibility was the most reported P-T domain (49.0%). Participants with LTFU, compared with those not LTFU, had more SRFs (100% vs. 52.4%, P = 0.0001) and reported a greater median number of SRFs (3.0 vs. 1.0, P < 0.0001).

Conclusions: SRFs affected most patients with MK, most notably accessibility and affordability. Participants with lower income had more SRFs. SRFs are linked to patients being lost to follow-up care.

Trial registration: ClinicalTrials.gov NCT04420962.

Keywords: barriers to care; loss to follow-up; microbial keratitis; social determinants of health; social risk factors.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
STROBE flow chart of participants, Strengthening the reporting of observational studies in Epidemiology. AQUA, Automated Quantitative Ulcer Analysis; UM, University of Michigan.
FIGURE 2.
FIGURE 2.
Distribution of participants experiencing social risk factors (SRFs) in each of the Penchansky–Thomas framework domains. *Other patient-level factors included personal matters and impeding life events not in the Penchansky–Thomas framework domains.
See this image and copyright information in PMC

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