Associations between Socioeconomic Factors and Visit Adherence among Patients with Glaucoma in the All of Us Research Program

Acuff, Kaela; Delavar, Arash Ghorbannia; Saseendrakumar, Bharanidharan Radha; Wu, Jo‐Hsuan; Weinreb, Robert N.; Baxter, Sally L.

doi:10.1016/j.ogla.2023.01.008

Ophthalmology Glaucoma

2023

DOI: 10.1016/j.ogla.2023.01.008

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Associations between Socioeconomic Factors and Visit Adherence among Patients with Glaucoma in the All of Us Research Program

Kaela Acuff

Arash Ghorbannia Delavar

Bharanidharan Radha Saseendrakumar

et al.

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Cited by 19 publications

(36 citation statements)

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“…4 Recent studies in ophthalmology further show that racial and ethnic disparities lead to poor outcomes of common vision-threatening diseases. 2,3 In this study, while patients in all racial and ethnic minority groups had increased odds of reporting unmet vision care needs compared with White individuals in the multivariable model, none of these differences reached statistical significance except for Black individuals. 1 However, current estimates of the Ohio population (11 756 058 residents) demonstrate far greater representation of non-Hispanic White residents (81.2%) when compared with minority groups (American Indian and Alaska Native residents, 0.3%; Asian residents, 2.7%; Black and African American residents, 13.2%; and Hispanic and Latino residents, 4.3% ).…”

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confidence: 54%

“…The greatest portion of younger uninsured individuals in the United States were Hispanic or Latino individuals (19.0%) and American Indian and Alaska Native individuals (21.2%) . Recent studies in ophthalmology further show that racial and ethnic disparities lead to poor outcomes of common vision-threatening diseases . In this study, while patients in all racial and ethnic minority groups had increased odds of reporting unmet vision care needs compared with White individuals in the multivariable model, none of these differences reached statistical significance except for Black individuals .…”

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confidence: 51%

“…This study increases awareness of the association of disparities in insurance coverage and other social determinants with vision care. Not only does this work add to the growing literature regarding eye care disparities, but it is also particularly salient given upcoming policy changes in Medicaid coverage across the United States.…”

mentioning

confidence: 95%

“…In fact, among the populations most likely to lose coverage or experience limited benefits from the expansion of Medicaid are those with limited English proficiency, those with disabilities, and those with income below the federal poverty level . This is an important distinction because these individuals are also most likely to have more severe ocular morbidities than their White counterparts who do not have these limitations . Given this, future work in this field should include analyses of data encompassing substantial minority representation, in order to reassess the risk these groups carry for unmet vision needs as policies evolve over time.…”

mentioning

confidence: 99%

“…In addition, a growing body of literature regarding disparities in health care experienced by underserved individuals could lead to greater awareness and inform subsequent policy changes to mitigate the risk of unmet care. For example, a recent study by Acuff et al identified factors associated with disruptions in glaucoma care by patients. Another study published within a similar time frame described how similar covariates, including race and ethnicity, were associated with increased severity of visual impairment .…”

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confidence: 99%

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Unmet Needs in Vision Care Among Vulnerable Patients

Copado

Baxter

2023

JAMA Ophthalmol

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In this issue of JAMA Ophthalmology, Muhammad et al 1 provide several insights into vision care gaps using data from adult Ohio residents. Through a cross-sectional survey of Ohio state Medicaid beneficiaries, they found that adults with yearround lack of insurance as well as those with recent gaps in health insurance coverage had a significantly increased risk of reporting unmet vision care needs compared with those who had continuous insurance coverage. This study increases awareness of the association of disparities in insurance coverage and other social determinants with vision care. Not only does this work add to the growing literature regarding eye care disparities, 2,3 but it is also particularly salient given upcoming policy changes in Medicaid coverage across the United States.Key study findings from a statewide survey of 19 036 participants found that an estimated 4% of adults self-reported insurance coverage gaps (ie, discontinuous coverage within the last 12 months), and another 4% were continuously lacking insurance coverage throughout the preceding year. 1 Furthermore, 13% of adults self-reported unmet needs in vision care. Of this group, 27% experienced some interruption in insurance coverage, while 47% had a year-round uninsured status. In a multivariable logistic regression model of unmet vision care needs, the authors selected a comprehensive list of covariates consistent with similar studies, including age, sex, race and ethnicity, education, employment, presence of children in the household, county type (metropolitan, suburban, or rural), annual household income, prior diagnosis of diabetes, and self-reported mental health concerns. In the model, adults with gaps in coverage or year-round lack of coverage were at significantly greater risk of experiencing unmet vision care needs when compared with others who had continuous private coverage or continuous public coverage. Examination of the main table describing the multivariable model also revealed significantly greater risk of unmet vision care needs among Black individuals compared with White individuals (OR, 1.4; 95% CI, 1.1-1.6; P = .003), among individuals with lower household incomes (OR, 1.7; 95% CI, 1.5-2.1; P < .001), and among those reporting that mental health concerns limited their work or activities in the last 30 days (OR, 2.2; 95% CI, 1.9-2.6; P < .001). There was significantly lower risk of unmet vision care needs among those with greater educational attainment (OR for 4-year college graduate compared with high school or less, 0.5; 95% CI, 0.4-0.6; P < .001) and among those with active employment (OR, 0.8; 95% CI, 0.6-0.9; P < .001). These results highlight several disparities in unmet vision care needs in addition to insurance coverage.The US Census American Community Survey of Medicaidaged enrollees found that people in racial and ethnic minority groups are more likely to be uninsured or experience gaps in health insurance. 4 The greatest portion of younger unin-

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confidence: 54%

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confidence: 51%

mentioning

confidence: 95%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Unmet Needs in Vision Care Among Vulnerable Patients

Copado

Baxter

2023

JAMA Ophthalmol

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

Chaudhury,

Ige,

Marwah

et al. 2024

JAMA Ophthalmol

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ImportanceBesides race, little is known about how other social determinants of health (SDOH) affect quality of diabetic eye care.ObjectiveTo evaluate the association between multiple SDOH and monitoring for diabetic retinopathy (DR) in accordance with clinical practice guidelines (CPGs).Design, Setting, and ParticipantsThis 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.ExposuresMultiple SDOH and associated factors, including ethnicity, urbanicity of residence, health insurance type, and diabetes type.Main Outcomes and MeasuresAdjusted odds ratio (aOR) of receiving 1 or more eye-care visits and 1 or more dilated fundus examinations in accordance with CPGs.ResultsThe 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 RelevanceThis 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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Socioeconomic Disparities in Glaucoma Severity at Initial Diagnosis: A Nationwide Electronic Health Record Cohort Analysis

SWAMINATHAN,

MEDEIROS

2024

American Journal of Ophthalmology

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Associations between Socioeconomic Factors and Visit Adherence among Patients with Glaucoma in the All of Us Research Program

Cited by 19 publications

References 23 publications

Unmet Needs in Vision Care Among Vulnerable Patients

Unmet Needs in Vision Care Among Vulnerable Patients

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

Socioeconomic Disparities in Glaucoma Severity at Initial Diagnosis: A Nationwide Electronic Health Record Cohort Analysis

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