Social Deprivation and the Risk of Screening Positive for Glaucoma in the MI-SIGHT Telemedicine-Based Glaucoma Detection Program

Cho, Juno; Aliancy, Joah; Lu, Ming-Chen; Woodward, Maria A.; Hicks, Patrice M.; Niziol, Leslie M.; Musch, David C.; Bicket, Amanda K.; John, Denise; Killeen, Olivia J.; Wood, Sarah Dougherty; Johnson, Leroy; Kershaw, Martha; Zhang, Jason; Elam, Angela R.

doi:10.1016/j.ophtha.2023.05.021

Cited by 12 publications

(11 citation statements)

References 35 publications

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“…Among the 112 690 participants recruited in the U.K. Biobank, Shweikh et al found the risk of glaucoma diagnosis to increase across the full range of income levels, with the highest risk observed among those in the lowest income group 34 . The work by Newman‐Casey et al further reported the association of a positive glaucoma screening result with both personal poverty and neighbourhood‐level poverty based on the Michigan Screening and Intervention for Glaucoma and eye Health through Telemedicine (MI‐SIGHT) program (1171 enrolled participants), and that MI‐SIGHT participants who screened positive for glaucoma had significantly worse area deprivation index than those who screened negative 17 . Interestingly, using the Taiwan National Health Insurance Research Database, Ko et al reported varying associations between individual SES (defined based on income level) and the risk of being diagnosed with different glaucoma subtypes after adjusting for other potential risk/protective factors, including age, gender, healthcare utilisation, and more 36 .…”

Section: Discussionmentioning

confidence: 99%

“…It is increasingly recognised that glaucoma is a condition with disproportionate impact and significant disparities throughout the course of disease presentation 4,5,15–18 . In addition to age and family history, 4 which are well‐established risk factors for glaucoma, many studies have revealed other social factors potentially affecting the prevalence and incidence of glaucoma 4,5,15–18 …”

Section: Discussionmentioning

confidence: 99%

“…Using the nationwide NIH All of Us database, Acuff et al analysed almost 3000 glaucoma patients and found that Black/African American participants and participants of other racial minorities were also diagnosed with glaucoma at earlier ages than White participants (mean 60 vs. 66 years), as were Hispanic or Latino patients when compared to non‐Hispanic or Latino White participants (mean 61 vs. 65 years) 5 . Overall, the higher prevalence and risk of having a diagnosis of glaucoma in Black/African American individuals compared with individuals of other races have been supported by various studies 17,20,21 …”

Section: Discussionmentioning

confidence: 99%

“…Some prior studies have found greater utilisation and better access to healthcare to correlate with a higher likelihood of glaucoma diagnosis, presumably due to the higher chance of receiving evaluation by ophthalmologists 17,36 . Chan et al assessed the self‐reported incidence of glaucoma in correlation with insurance status among 2619 White participants in the Canadian longitudinal National Population Health Survey 41 .…”

Section: Discussionmentioning

confidence: 99%

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Social determinants of health and health disparities in glaucoma: A review

Acuff,

Wu,

Varkhedi

et al. 2024

Clinical Exper Ophthalmology

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Social determinants of health and barriers to care can significantly impact patients' access to glaucoma care and treatment, resulting in disparities within disease presentation, progression, management, and treatment outcomes. The widespread adoption of electronic health record systems has allowed researchers and clinicians to further explore these relationships, identifying factors such as race, ethnicity, and socioeconomic status to be risk factors for more severe disease and lower treatment adherence. These disparities highlight potential targets for interventions to combat these disparities and improve overall patient outcomes. This article provides a summary of the available data on health disparities within glaucoma disease presentation, progression, management, treatment, and outcomes and discusses interventions to improve care delivery and outcomes among patients with glaucoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Social determinants of health and health disparities in glaucoma: A review

Acuff,

Wu,

Varkhedi

et al. 2024

Clinical Exper Ophthalmology

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“…These data contribute to the growing evidence that place-based deprivation is associated with eye health and vision outcomes, including microbial keratitis, glaucoma, amblyopia, and visual impairment and blindness. [11][12][13]15,26 The use of the THI for racial segregation, the Gini index of income inequality, and persistent poverty within a census tract have been previously explored in the ophthalmic literature in varying capacities. In 1 study, 11 living in an area with a high THI was associated with increased risk for worse presenting visual acuity among people with microbial keratitis (OR of 1.44 per 0.1-unit increase in THI of presenting with worse than 20/40 best-corrected visual acuity).…”

Section: Discussionmentioning

confidence: 99%

Place-Based Measures of Inequity and Vision Difficulty and Blindness

Hicks,

Lin,

Newman-Casey

et al. 2024

JAMA Ophthalmol

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ImportanceKnown social risk factors associated with poor visual and systemic health in the US include segregation, income inequality, and persistent poverty.ObjectiveTo investigate the association of vision difficulty, including blindness, in neighborhoods with measures of inequity (Theil H index, Gini index, and persistent poverty).Design, Setting, and ParticipantsThis cross-sectional study used data from the 2012-2016 American Community Survey and 2010 US census tracts as well as Theil H index, Gini index, and persistent poverty measures from PolicyMap. Data analysis was completed in July 2023.Main Outcomes and MeasuresThe main outcome was the number of census tract residents reporting vision difficulty and blindness (VDB) and the association with the Theil H index, Gini index, or persistent poverty, assessed using logistic regression.ResultsIn total, 73 198 census tracts were analyzed. For every 0.1-unit increase in Theil H index and Gini index, there was an increased odds of VDB after controlling for census tract–level median age, the percentage of the population that identified as female sex, the percentage of the population that identified as a member of a racial or ethnic minority group, state, and population size (Theil H index: odds ratio [OR], 1.14 [95% CI, 1.14-1.14; P &lt; .001]; Gini index: OR, 1.15 [95% CI, 1.15-1.15; P &lt; .001]). Persistent poverty was associated with an increased odds of VDB after controlling for census tract–level median age, the percentage of the population that identified as female sex, the percentage of the population that identified as a member of a racial or ethnic minority group, state, and population size compared with nonpersistent poverty (OR, 1.36; 95% CI, 1.35-1.36; P &lt; .001).Conclusions and RelevanceIn this cross-sectional study, residential measures of inequity through segregation, income inequality, or persistent poverty were associated with a greater number of residents living with VDB. It is essential to understand and address how neighborhood characteristics can impact rates of VDB.

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A Screening Strategy to Mitigate Vision Impairment by Engaging Adults Who Underuse Eye Care Services

Sherman,

Niziol,

Hicks

et al. 2024

JAMA Ophthalmol

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ImportanceUnderuse of eye care services leads to underdiagnosed and undertreated eye disease.ObjectiveTo assess the reasons for underuse of eye care and whether a novel, free eye disease screening program is engaging adults who are both at high risk of eye disease and were underusing eye care services.Design, Setting, and ParticipantsIn a population-based cross-sectional study, adult participants from the first year of the Michigan Screening and Intervention for Glaucoma and Eye Health Through Telemedicine (MI-SIGHT) Program were included. The participants were recruited from primary care clinics serving 2 low-income communities. Recruitment occurred between June 28, 2020 and June 27, 2021 at the free clinic, and between January 27, 2021 and January 26, 2022 at a federally qualified health clinic. Data were analyzed from December 7, 2022, to May 29, 2024. Participants received comprehensive eye disease screening and completed surveys assessing health and prior eye care use. Risk factors for eye disease included age 65 years and older, diabetes, personal or family history of eye disease, and self-identifying as Black or African American individuals who were aged 50 years or older. Underuse of eye care was defined as no eye examination in 2 or more years.Main Outcomes and MeasuresPercentage of participants who were at high risk of eye disease and underused eye care services before accessing this program.ResultsA total of 1171 MI-SIGHT participants were a mean (SD) age of 55 (14.5) years; 437 (38%) identified as male; 591 (54%) self-identified as Black or African American, 101 (10%) as Hispanic or Latino, and 371 (34%) as White; 492 (43%) had high school education or less, and 696 (70%) reported an annual household income of less than $30 000. Characteristics of participants reporting not having had an eye examination in 2 years or more included 23% (n = 151) of participants 65 years and over, 33% (n = 214) of participants who self-reported diabetes, 25% (n = 130) of participants reporting a family history of glaucoma, 3% (n = 14) of those with self-reported glaucoma; and 33% (n = 202) of Black or African-American participants aged 50 years and older. In participants who reported not having had an eye examination in 2 or more years, 21% (n = 137) screened positive for glaucoma, 20% (n = 129) for cataract, 6% (n = 38) for diabetic retinopathy, and 1% (n = 9) for age-related macular degeneration. Reported reasons for why participants had not had an eye examination included no insurance (175 of 627 [28%]), no reason to go (no problem) (135 of 627 [22%]), and cost of eye examination (101 of 627 [16%]).Conclusions and RelevanceThe findings of this study suggest that placing eye disease detection programs in primary care clinics in underserved areas may improve eye disease detection and treatment, possibly mitigating needless vision loss in the US.

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Social Deprivation and the Risk of Screening Positive for Glaucoma in the MI-SIGHT Telemedicine-Based Glaucoma Detection Program

Cited by 12 publications

References 35 publications

Social determinants of health and health disparities in glaucoma: A review

Social determinants of health and health disparities in glaucoma: A review

Place-Based Measures of Inequity and Vision Difficulty and Blindness

A Screening Strategy to Mitigate Vision Impairment by Engaging Adults Who Underuse Eye Care Services

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