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Hicks PM, Lu MC, Woodward MA, Niziol LM, Darnley-Fisch D, Heisler M, Resnicow K, Musch DC, Mitchell J, Mehdipanah R, Imami NR, Newman-Casey PA. Relationship between Neighborhood-Level Social Risk Factor Measures and Presenting Glaucoma Severity Utilizing Multilevel Modeling. OPHTHALMOLOGY SCIENCE 2025; 5:100598. [PMID: 39346573 PMCID: PMC11437858 DOI: 10.1016/j.xops.2024.100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 10/01/2024]
Abstract
Purpose The neighborhood and built environment social determinant of health domain has several social risk factors (SRFs) that are modifiable through policy efforts. We investigated the impact of neighborhood-level SRFs on presenting glaucoma severity at a tertiary eye care center. Design A cross-sectional study from August 2012 to May 2022 in the University of Michigan electronic health record (EHR). Participants Patients with a diagnosis of any open-angle glaucoma with ≥1 eye care visit at the University of Michigan Kellogg Eye Center and ≥1 reliable visual field (VF). Methods Participants who met inclusion criteria were identified by International Classification of Diseases ninth and tenth revision codes (365.x/H40.x). Data extracted from the EHR included patient demographics, address, presenting mean deviation (MD), and VF reliability. Addresses were mapped to SRF measures at the census tract, block group, and county levels. Multilevel linear regression models were used to estimate the fixed effects of each SRF on MD, after adjusting for patient-level demographic factors and a random effect for neighborhood. Interactions between each SRF measure with patient-level race and Medicaid status were tested for an additive effect on MD. Main Outcome Measures The main outcome measure was the effect of SRF on presenting MD. Results In total, 4428 patients were included in the analysis who were, on average, 70.3 years old (standard deviation = 11.9), 52.6% self-identified as female, 75.8% self-identified as White race, and 8.9% had Medicaid. The median value of presenting MD was -4.94 decibels (dB) (interquartile range = -11.45 to -2.07 dB). Neighborhood differences accounted for 4.4% of the variability in presenting MD. Neighborhood-level measures, including worse area deprivation (estimate, β = -0.31 per 1-unit increase; P < 0.001), increased segregation (β = -0.92 per 0.1-unit increase in Theil's H index; P < 0.001), and increased neighborhood Medicaid (β = -0.68; P < 0.001) were associated with worse presenting MD. Significant interaction effects with race and Medicaid status were found in several neighborhood-level SRF measures. Conclusions Although patients' neighborhood SRF measures accounted for a minority of the variability in presenting MD, most neighborhood-level SRFs are modifiable and were associated with clinically meaningful differences in presenting MD. Policies that aim to reduce neighborhood inequities by addressing allocation of resources could have lasting impacts on vision outcomes. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Patrice M Hicks
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ming-Chen Lu
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Michele Heisler
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jamie Mitchell
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Roshanak Mehdipanah
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Nauman R Imami
- Department of Ophthalmology, Henry Ford Health System, Detroit, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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de Youngster S, Li SA. Use of Subsidized Health Services by Artists in Canada: An Exploratory Study. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241290666. [PMID: 39395018 DOI: 10.1177/2752535x241290666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2024]
Abstract
INTRODUCTION Creative and performing artists are often confronted with precarious employment and insufficient healthcare coverage. A clinic in Canada that provides specialized healthcare to artists offers eligible artists subsidized health services. We aim to compare the use of health services, demographics and health conditions between subsidy artist recipients (SAs) and non-subsidy artists (NSAs). METHODS We accessed existing data from 265 SAs and 711 NSAs and applied descriptive and inferential statistics to address our research questions. RESULTS Musculoskeletal issues, stress, anxiety disorders, and depressive disorders are the most common health problems faced by SAs. Compared to NSAs, SAs were more likely to seek treatment for stress, but less likely to seek treatment for anxiety disorders, depressive disorders, chronic problems, and upper extremity problems. DISCUSSION Future research may investigate the enduring effects of subsidized health services on SAs' health outcomes. Sustained positive outcomes are crucial for maintaining an artist's career and well-being.
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Affiliation(s)
- Sesinam de Youngster
- The Al & Malka Green Artists' Health Centre, University Health Network, Toronto, ON, Canada
| | - Shelly-Anne Li
- The Al & Malka Green Artists' Health Centre, University Health Network, Toronto, ON, Canada
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Khurana RN, Wang JC, Zhang S, Li C, Lum F. Loss to Follow up in Patients with Proliferative Diabetic Retinopathy Treated with Anti-VEGF Therapy and/or Panretinal Photocoagulation in the United States. Ophthalmol Retina 2024; 8:953-961. [PMID: 38657954 DOI: 10.1016/j.oret.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To determine the rate of loss to follow up (LTFU) in patients with proliferative diabetic retinopathy (PDR) treated with anti-VEGF therapy and/or panretinal photocoagulation (PRP) in the United States. DESIGN Retrospective cohort study using the national IRIS® (Intelligent Research in Sight) Registry data. SUBJECTS A total of 73 595 eyes of 56 590 patients with PDR diagnosed between 2013 and 2015 and treated between 2013 and 2018. METHODS Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). MAIN OUTCOME MEASURES Loss to follow up was no follow up within 12 months from last treatment. RESULTS For patient eyes treated for PDR, 11.7% (95% CI, 11.5-12.0) were LTFU. Among patients with PDR treated with anti-VEGF therapy alone, PRP alone, and anti-VEGF and PRP, the rates of LTFU were 12.3% (95% CI, 11.8-12.7), 12.6% (95% CI, 12.1-13.0), and 10.8% (95% CI, 10.4-11.1), respectively. Risk factors for LTFU include Black or African American race/ethnicity (odds ratio [OR], 1.26; 95% CI, 1.13-1.41; P < 0.001), Hispanic ethnicity (OR, 1.28; 95% CI, 1.16-1.42; P < 0.001), Native American/Alaska Native or Native Hawaiian/Other Pacific Islander race/ethnicity (OR, 2.69; 95% CI, 2.14-3.38; P < 0.001), and unilateral disease (OR, 2.05; CI, 1.88-2.23; P < 0.001). Odds for LTFU were higher with patients with baseline vision of 20/50 to 20/200 (OR, 1.25; 95% CI, 1.15-1.36; P < 0.001) and with vision worse than 20/200 (OR, 1.22; 95% CI, 1.05-1.42; P = 0.01) than for patient eyes with a baseline visual acuity of 20/40 or better. Odds for LTFU were lower for Medicare Fee-for-Service (OR, 0.71; 95% CI, 0.64-0.79; P < 0.001) and Medicare Managed (OR, 0.66; 95% CI, 0.56-0.78; P < 0.001) compared with private insurance. Odds for LTFU were lower for patients treated in the Midwest (OR, 0.72; 95% CI, 0.64-0.81; P < 0.001) and West (OR, 0.83; 95% CI, 0.74-0.94; P = 0.003) compared with in the South region. CONCLUSIONS The rate of LTFU is between 10% and 12% among patients with PDR who were treated with anti-VEGF injections and/or PRP. Risk factors include Black or African American race/ethnicity, Hispanic ethnicity, baseline vision worse than 20/40, private insurance, South region, and unilateral disease. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Rahul N Khurana
- Northern California Retina Vitreous Associates, Mountain View, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
| | - Jay C Wang
- Northern California Retina Vitreous Associates, Mountain View, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Sen Zhang
- American Academy of Ophthalmology, San Francisco, California
| | - Charles Li
- American Academy of Ophthalmology, San Francisco, California
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
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Tang T, Tran D, Han D, Zeger SL, Crews DC, Cai CX. Place, Race, and Lapses in Diabetic Retinopathy Care. JAMA Ophthalmol 2024; 142:581-583. [PMID: 38662344 PMCID: PMC11046402 DOI: 10.1001/jamaophthalmol.2024.0974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/24/2024] [Indexed: 04/26/2024]
Abstract
This cohort study investigates the association of neighborhood-level social determinants of health with lapses in diabetic retinopathy care by race and ethnicity.
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Affiliation(s)
- Tina Tang
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Diep Tran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Dingfen Han
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Scott L. Zeger
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Deidra C. Crews
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cindy X. Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Goldman AW, Pinto JM. Sensory Health Among Older Adults in the United States: A Neighborhood Context Approach. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae003. [PMID: 38267366 PMCID: PMC10998359 DOI: 10.1093/geronb/gbae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVES Sensory health declines with age but remains critical to the navigation and enjoyment of everyday life. Neighborhoods are key sites of environmental exposure, social engagement, and access to resources that can shape sensory health, yet the residential neighborhood is understudied as a determinant of sensory function. METHODS We use data from Rounds 1 and 2 of the National Social Life, Health, and Aging Project to examine how subjective and objective measures of older adults' residential areas are associated with sensory health in a series of cross-sectional and multilevel regression models. RESULTS In cross-sectional models, higher levels of perceived neighborhood social ties are associated with significantly better self-rated vision. Older adults who reside in more densely populated tracts are more likely to have significantly worse olfactory identification, whereas residing in tracts with higher levels of concentrated disadvantage is associated with significantly lower levels of self-rated vision. In multilevel models, residing in more densely populated tracts is associated with significantly worse olfactory identification, whereas tract-level concentrated disadvantage is associated with significantly worse hearing and vision. DISCUSSION We propose that neighborhood characteristics could influence certain environmental exposures, the amount of time that older adults spend out of the home, patterns of social engagement, and access to preventative care that collectively affect sensory health. Residential neighborhoods may be important sites of potential intervention to slow age-related sensory declines and other related conditions.
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Affiliation(s)
- Alyssa W Goldman
- Department of Sociology, Boston College, Chestnut Hill, Massachusetts, USA
| | - Jayant M Pinto
- Department of Surgery, Section of Otolaryngology, University of Chicago Medicine, Chicago, Illinois, USA
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Mzumara T, Kantaris M, Afonne J. Eye Care Service Use and Associated Health-Seeking Behaviors Among Malawian Adults: Secondary Analysis of the Malawi Fifth Integrated Household Survey 2019-2020. JMIRX MED 2024; 5:e44381. [PMID: 38602316 PMCID: PMC11024398 DOI: 10.2196/44381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/07/2024] [Accepted: 02/19/2024] [Indexed: 04/12/2024]
Abstract
Background The use of eye care services varies among different population groups. Objective This study aimed to assess self-reported eye care use (ECU) and associated demographic factors among Malawian adults. Methods This study used secondary data from the Malawi Fifth Integrated Household Survey 2019-2020, a nationally representative survey. The study included 12,288 households and 27,336 individuals 15 years and older. We entered age, sex, level of education, residency (urban/rural), and chronic disease into a logistic regression model, and used a confusion matrix to predict the model's accuracy. A P value <.05 was considered statistically significant. Results About 60.6% (95% CI 60.0%-61.2%) of those with eye problems accessed formal care 2 weeks before the survey date. A logistic regression model showed that ECU was positively associated with education compared to none (odds ratio [OR] 6.6, 95% CI 5.927-7.366; P<.001), males compared to females (OR 1.2, 95% CI 1.104-1.290; P<.001), and urban residence compared to rural (OR 1.2, 95% CI 1.118-1.375; P<.001). ECU was negatively associated with age (OR 7, 95% CI 6.782-8.476; P<.001) and having chronic diseases (OR 0.6, 95% CI 0.547-0.708; P<.001). Conclusions Social support, women empowerment, education, and mobile clinics are key strategic areas that would increase access to eye care in Malawi. Further studies can investigate ECU among the pediatric population.
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Affiliation(s)
- Thokozani Mzumara
- Department of Optometry, Mzuzu University, Mzuzu, Malawi
- Department of Ophthalmology, Mzimba North District Hospital, Ministry of Health, Mzuzu, Malawi
- Unicaf University, Lusaka, Zambia
| | - Marios Kantaris
- Unicaf University, Lusaka, Zambia
- Health Services and Social Policy Research Centre, Nicosia, Cyprus
| | - Joseph Afonne
- Department of Optometry, Mzuzu University, Mzuzu, Malawi
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Rein DB, Herring-Nathan ER. Vision Need Profiles for the City of Richmond, Virginia: A Pilot Application of Calibration Methods to Vision Surveillance. OPHTHALMOLOGY SCIENCE 2024; 4:100429. [PMID: 38187127 PMCID: PMC10767496 DOI: 10.1016/j.xops.2023.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024]
Abstract
Purpose People with vision problems (VPs) have different needs based on their age, economic resources, housing type, neighborhood, and other disabilities. We used calibration methods to create synthetic data to estimate census tract-level community need profiles (CNPs) for the city of Richmond, Virginia. Design Cross-sectional secondary data analysis. Subjects Anonymized respondents to the 2015 to 2019 American Community Survey (ACS). Methods We used calibration methods to transform the ACS 5-year tabular (2015-2019) and Public Use Microdata estimates into a synthetic data set of person-level records in each census tract, and subset the data to persons who answered yes to the question "Are you blind or do you have serious difficulty seeing even when wearing glasses?" To identify individual need profiles (INPs), we applied divisive clustering to 17 variables measuring individual demographics, nonvision disability status, socioeconomic status (SES), housing, and access and independence. We labeled tracts with CNP names based on their predominant INPs and performed sensitivity analyses. We mapped the CNPs and overlayed information on the number of people with VP, the National Walkability Index, and an uncertainty measure based on our sensitivity analysis. Main Outcome Measures Individual need profiles and CNPs. Results Compared with people without VP, people with VP exhibited higher rates of disabilities, having low incomes, living alone, and lacking access to the internet or private home vehicles. Among people with VP, we identified 7 INP clusters which we mapped into 6 CNPs: (1) seniors (≥ age 65); (2) low SES younger; (3) low SES older; (4) mixed SES; (5) higher SES; and (6) adults and children in group quarters. Three CNPs had lower-than-average walkability. Community need profile assignments were somewhat sensitive to calibration variables, with 18 tracts changing assignments in 1 sensitivity analysis, and 4 tracts changing assignments in ≥ 2 sensitivity analyses. Conclusions This pilot project illustrates the feasibility of using ACS data to better understand the support and service needs of people with VP at the census tract level. However, a subset of categorical CNP assignments were sensitive to variable selection leading to uncertainty in CNP assignment in certain tracts. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Cai CX, Han D, Tran D, Moreno JA, Zeger SL, Crews DC. Social Risk Groups in Patients With Diabetes With Differing Eye Care Utilization and Vision Outcomes. Transl Vis Sci Technol 2024; 13:13. [PMID: 38497518 PMCID: PMC10950035 DOI: 10.1167/tvst.13.3.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
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.
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Affiliation(s)
- Cindy X. Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Dingfen Han
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Diep Tran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Scott L. Zeger
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Deidra C. Crews
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Ravindranath R, Bernstein IA, Fernandez KS, Ludwig CA, Wang SY. Social Determinants of Health and Perceived Barriers to Care in Diabetic Retinopathy Screening. JAMA Ophthalmol 2023; 141:1161-1171. [PMID: 37971726 PMCID: PMC10654926 DOI: 10.1001/jamaophthalmol.2023.5287] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023]
Abstract
Importance Regular screening for diabetic retinopathy often is crucial for the health of patients with diabetes. However, many factors may be barriers to regular screening and associated with disparities in screening rates. Objective To evaluate the associations between visiting an eye care practitioner for diabetic retinopathy screening and factors related to overall health and social determinants of health, including socioeconomic status and health care access and utilization. Design, Setting, and Participants This retrospective cross-sectional study included adults aged 18 years or older with type 2 diabetes who answered survey questions in the All of Us Research Program, a national multicenter cohort of patients contributing electronic health records and survey data, who were enrolled from May 1, 2018, to July 1, 2022. Exposures The associations between visiting an eye care practitioner and (1) demographic and socioeconomic factors and (2) responses to the Health Care Access and Utilization, Social Determinants of Health, and Overall Health surveys were investigated using univariable and multivariable logistic regressions. Main Outcome and Measures The primary outcome was whether patients self-reported visiting an eye care practitioner in the past 12 months. The associations between visiting an eye care practitioner and demographic and socioeconomic factors and responses to the Health Care Access and Utilization, Social Determinants of Health, and Overall Health surveys in All of Us were investigated using univariable and multivariable logistic regression. Results Of the 11 551 included participants (54.55% cisgender women; mean [SD] age, 64.71 [11.82] years), 7983 (69.11%) self-reported visiting an eye care practitioner in the past year. Individuals who thought practitioner concordance was somewhat or very important were less likely to have seen an eye care practitioner (somewhat important: adjusted odds ratio [AOR], 0.83 [95% CI, 0.74-0.93]; very important: AOR, 0.85 [95% CI, 0.76-0.95]). Compared with financially stable participants, individuals with food or housing insecurity were less likely to visit an eye care practitioner (food insecurity: AOR, 0.75 [95% CI, 0.61-0.91]; housing insecurity: AOR, 0.86 [95% CI, 0.75-0.98]). Individuals who reported fair mental health were less likely to visit an eye care practitioner than were those who reported good mental health (AOR, 0.84; 95% CI, 0.74-0.96). Conclusions and Relevance This study found that food insecurity, housing insecurity, mental health concerns, and the perceived importance of practitioner concordance were associated with a lower likelihood of receiving eye care. Such findings highlight the self-reported barriers to seeking care and the importance of taking steps to promote health equity.
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Affiliation(s)
- Rohith Ravindranath
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Isaac A. Bernstein
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Karen S. Fernandez
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Cassie A. Ludwig
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Sophia Y. Wang
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
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Jamal O, Mallipatna A, Hwang SW, Dimaras H. Social Determinants of Health in Pediatric Ophthalmology Patients: Availability of Data in the Electronic Health Record and Association With Clinic Attendance. Transl Vis Sci Technol 2023; 12:36. [PMID: 38019501 PMCID: PMC10691384 DOI: 10.1167/tvst.12.11.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023] Open
Abstract
Purpose To characterize the availability of social determinants of health data in the electronic health record of pediatric ophthalmology patients and to examine the association of social determinants of health with attendance at scheduled operating room and clinic visits. Methods This was a retrospective cohort study of pediatric ophthalmology patients seen at The Hospital for Sick Children between June 1, 2018, and May 23, 2022. Data were collected on demographics, diagnosis, and management-plan. The χ2 tests and multivariable regression were used to examine associations between social determinants of health and attendance at scheduled operating room and clinic visits. Results The cohort consisted of 26,102 study subjects with 31,288 unique eye-related diagnoses representing 57 unique ICD-10 codes. Availability of data in the electronic health record ranged from 100% for sex, age and postal code to 0.1% for ethnic group. Female sex (P = 0.004) and urbanicity (P = 0.05) were associated with higher operating room visit cancellations. Female sex (P = 0.002), age group 0-13 (P ≤ 0.001), low-medium neighborhood income quintile (P ≤ 0.001), residence of Northern Ontario (P ≤ 0.001), and urbanicity (P ≤ 0.001) were associated with higher clinic visit cancellations and no-shows. Conclusions At a major tertiary-care hospital in Canada, key social determinant data such as ethnicity are not consistently available in the electronic health record of pediatric ophthalmology patients. Female sex, younger age, and living in a rural area or neighborhood with low-medium income quintile may be predictors of missed visits and require further study. Translational Relevance This study highlights a need for improved documentation of social determinants of health variables in electronic health records.
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Affiliation(s)
- Omer Jamal
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
- University of Toronto, Institute of Medical Sciences, Toronto, Canada
| | - Ashwin Mallipatna
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
- University of Toronto, Institute of Medical Sciences, Toronto, Canada
- Department of Ophthalmology & Vision Sciences, Faculty of Medicine & Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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