The social determinants of health (SDoH) that affect retinal care was the subject of 2 presentations at the American Society of Retina Specialists 2024 Annual Meeting in Stockholm. Social determinants of health are the conditions in which people live, work, and play, as well as the wider set of social structures and economic systems that shape daily living. Increasingly, evidence is showing that SDoH play critical roles in health behaviors and health outcomes.
Rhematogenous Retinal Detachment and SDoH
In her talk, Dr Sally Ong focused on “Individual and Neighborhood-Level Socioeconomic Characteristics Associated With Presenting Visual Acuity and Foveal Status in Rhegmatogenous Retinal Detachment.” Visual outcomes after rhegmatogenous retinal detachment (RRD) repair are influenced by preoperative factors (e.g., fovea/macula status, ocular comorbidities), intraoperative factors (e.g., use of pars plana vitrectomy vs scleral buckle), and postoperative factors. “After decades of research, we now know that the strongest predictors of final visual acuity remain the baseline visual acuity and the fovea status at presentation,” said Dr. Ong.
While SDoH are important contributors to visual outcomes in glaucoma, cataracts, diabetic retinopathy, and macular degeneration, their effects on RRD have not been widely studied. Dr. Ong and her team conducted a retrospective cohort study that evaluated the association of multiple neighborhood-level indicators of SDoH with baseline severity of primary RRD in 700 patients with uncomplicated RRD who had repair procedures at the Wilmer Eye Institute between 2008 and 2018. Census block groups of patient home addresses were matched to certain SDoH factors, including Area Deprivation Index, income, and number of uninsured people in the household.
In these patients, worse vision (visual acuity [VA] <20/40) was found to be significantly associated with older age, non-Hispanic Black race, and having public or no insurance vs private insurance. The SDoH that were significantly associated with worse vision and foveal-involving RRD were worse Area Deprivation Index scores (indicating more socioeconomic deprivation) and higher percentage of workers driving to work (vs taking public transportation).
In the literature, higher per capita income has been linked to higher cataract surgery rates. Dr. Ong noted, “Our finding that higher per capita income was associated with better baseline visual acuity but not foveal involvement could partially be confounded by the association with cataract surgery rate.”
Eye Care Utilization and SDoH
Following Dr. Ong’s talk, the findings of which she briefly acknowledged, Cindy Cai, MD, presented on “The Impact of Social Determinants of Health on Eye Care Utilization in a National Sample of People With Diabetes.” Pooled data from a 2013–2017 National Health Interview Survey sample population of 20,807 adults with self-reported diabetes were combined with 55 questions (33 SDoH variables) from the Kaiser Family Foundation framework related to economic stability, neighborhood and physical environment, education, food, community and social context, and health care systems.1
Only 57% of patients met the main outcome of self-reported eye care utilization in the preceding 12 months. Factors associated with no eye care utilization included no health insurance, lower education levels, food insecurity, and low family income.
Dr. Cai concluded by noting that a greater burden of adverse SDoH in the aggregate led to less eye care utilization. “Hopefully, evaluating and addressing these multidimensional adverse SDoH could be a means by which we improve eye care utilization and prevent vision loss in this population.”
Reference
1. Taccheri C et al. Ophthalmology. 2023;130(10):1037-1045.