Relationship between Neighborhood-Level Social Risk Factor Measures and Presenting Glaucoma Severity Utilizing...

Area of Science:

• Ophthalmology
• Public Health
• Social Determinants of Health

Background:

• Social determinants of health (SDOH), specifically neighborhood and built environment factors, encompass modifiable social risk factors (SRFs).
• Investigating the influence of these neighborhood-level SRFs on health outcomes is crucial for targeted policy interventions.

Purpose of the Study:

• To examine the association between neighborhood-level social risk factors (SRFs) and the severity of presenting glaucoma.
• To determine if factors like area deprivation, segregation, and neighborhood Medicaid status correlate with glaucoma severity.

Main Methods:

• A cross-sectional study analyzed electronic health records (EHR) of 4428 patients with open-angle glaucoma from August 2012 to May 2022.
• Neighborhood SRFs were mapped to patient addresses and analyzed using multilevel linear regression, adjusting for patient demographics.
• Interactions between SRFs, race, and Medicaid status were assessed for their impact on presenting mean deviation (MD).

Main Results:

• Neighborhood factors explained 4.4% of the variability in presenting mean deviation (MD).
• Worse area deprivation, increased segregation, and higher neighborhood Medicaid prevalence were significantly associated with worse presenting MD.
• Significant interaction effects were observed between neighborhood SRFs and patient-level race and Medicaid status.

Conclusions:

• While neighborhood SRFs account for a small portion of variability in glaucoma severity, they are modifiable and linked to clinically significant differences in outcomes.
• Policies aimed at reducing neighborhood inequities and improving resource allocation hold potential for improving long-term vision health.