Racial Disparities in Barriers to Care for Patients With Diabetic Retinopathy in a Nationwide Cohort

Abstract

Purpose To ascertain specific barriers of care among patients with diabetic retinopathy (DR) from different racial/ethnic groups. Methods In this cross-sectional study, we included adult participants in the National Institutes of Health All of Us Research Program with DR who answered questions in the Healthcare Access & Utilization survey and Social Determinants of Health (SDoH) survey. Logistic regression was used to study the association between barriers to care and race/ethnicity. Results Our cohort included 885 DR patients who answered the Healthcare Access & Utilization survey and 385 DR patients who responded to the SDoH survey. After adjusting for confounders, Hispanic individuals were more likely than non-Hispanic White individuals to report delaying getting medical care due to not being able to get child care (odds ratio [OR] = 6.57 [95% confidence interval {CI}, 1.67–27.8]). Furthermore, compared to non-Hispanic White individuals, non-Hispanic Black individuals were significantly more likely to report being treated with less respect (OR = 2.62 [95% CI, 1.15–5.80]), treated with less courtesy (OR = 2.51 [95% CI, 1.01–5.92]), and receive poorer service than other people (OR = 2.85 [95% CI, 1.25–6.34]) when they go to a doctor's office or other healthcare provider. Conclusions We found that Hispanic and non-Hispanic Black individuals with DR reported greater delays/barriers to care compared to non-Hispanic White individuals even after controlling for individualized socioeconomic factors. Translational Relevance This study highlights the importance of taking steps to promote health equity, such as increasing access to child care resources and reducing implicit bias among eye care providers, to increase access to care and prevent vision loss from DR.

Social Determinants of Health and Perceived Barriers to Care in Diabetic Retinopathy Screening

“…Hispanic individuals with diabetes are also more likely to face language barriers and struggles with health care costs. 42 In previous studies, 14,18,42 as well as in ours, the quality of communication with the physician was a key factor. Our results demonstrated the importance of practitioner concordance in relation to delaying eye care, suggesting the potential importance of enhancing workforce diversity and implementing cultural competency training to bridge the gap between patient-physician discordance.…”

“…41 Our findings are consistent with the themes of prior studies elucidating why certain racial and ethnic minority groups face barriers to DR care. Huang et al 14 found that non-Hispanic Black individuals were more prone to experience less respect, courtesy, and poorer service. Similarly, Owsley et al 18 reported that transportation, trusting the physician, and communicating with the physician were perceived barriers to care for African American individuals.…”

“…Numerous studies have examined factors associated with reduced DR screening rates among patients with diabetes . Such factors encompass younger age, minority racial or ethnic group, lower levels of income or education, neighborhood deprivation, and unfavorable housing conditions .…”

“…4 Numerous studies have examined factors associated with reduced DR screening rates among patients with diabetes. [5][6][7][8][9][10][11][12][13][14] Such factors encompass younger age, 5 minority racial or ethnic group, 5,11,12 lower levels of income or education, 5 neighborhood deprivation, 7,13 and unfavorable housing conditions. 10,13 While previous research has acknowledged various socioeconomic variables that are associated with lower adherence to DR screening, few studies have delved into patients' perspectives to elucidate the reasons behind this discrepancy.…”

“…10,13 While previous research has acknowledged various socioeconomic variables that are associated with lower adherence to DR screening, few studies have delved into patients' perspectives to elucidate the reasons behind this discrepancy. 13,14 Studies that analyze the effects of patient-reported factors for eye conditions and social determinants of health (SDOH) are prevalent, but studies focusing on these topics in DR screening are sparse. [15][16][17][18] The All of Us Research Program, funded and administered by the National Institutes of Health, presents a promising opportunity for investigating these issues.…”