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Area deprivation index predicts follow-up in retinopathy of prematurity
Rebecca E Tanenbaum1, Nikita Mokhashi1, Alexis K Warren1
1Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois.
Insights
Infants with higher area deprivation index (ADI) scores, indicating neighborhood disadvantage, were more likely to miss their first retinopathy of prematurity (ROP) follow-up appointments after hospital discharge.
Area of Science:
- Ophthalmology
- Public Health
- Neonatology
Background:
- Retinopathy of prematurity (ROP) requires ongoing outpatient follow-up post-discharge.
- Successful ROP management depends on coordinated care and patient attendance.
- Social determinants of health significantly influence healthcare access and outcomes.
Purpose of the Study:
- To investigate the association between neighborhood socioeconomic status, measured by the area deprivation index (ADI), and attendance at initial outpatient ROP examinations.
- To identify social drivers of health impacting follow-up care for infants with ROP.
Main Methods:
- Retrospective review of medical records for infants evaluated for ROP (January 2016-May 2023) at a major academic medical center.
- Extracted demographic data including birth weight, gestational age, sex, race, ethnicity, and insurance status.
- Calculated ADI based on maternal demographic data and performed logistic regression to identify predictors of missed appointments.
Main Results:
- 32% of 540 infants requiring post-discharge ROP evaluations missed their first outpatient appointment.
- Each one-level increase in ADI was associated with a 17% increase in the odds of missing the initial follow-up appointment (P < 0.001).
- Race/ethnicity showed an association with missed follow-up in unadjusted analysis, but this became nonsignificant after adjusting for ADI.
Conclusions:
- Neighborhood disadvantage, as indicated by a higher ADI, is a significant risk factor for missed outpatient follow-up in infants with retinopathy of prematurity.
- Area deprivation index is a valuable tool for identifying vulnerable populations at risk for poor ROP care adherence.
- Targeted interventions addressing social drivers of health are crucial for improving ROP follow-up rates in disadvantaged communities.
Background:
The risk of progression or development of retinopathy of prematurity (ROP) persists after hospital discharge, and successful outpatient follow-up requires extensive coordination. This study aimed to evaluate the impact of social drivers of health on attendance at outpatient ROP examinations using an area deprivation index (ADI), a census-based composite score indicating neighborhood affluence and opportunity.
Methods:
The medical records of infants evaluated for ROP between January 1, 2016, and May 1, 2023, at the University of Chicago Medical Center were reviewed. The following demographic data were extracted from the record: birth weight, gestational age, sex, race, ethnicity, and insurance status. ADI was calculated based on available maternal demographic data. Univariate and multivariable logistic regressions were performed to evaluate predictors of missed first outpatient appointment.
Results:
A total of 540 infants who were evaluated during the study period required additional ROP examinations after discharge. Of these, 174 patients (32%) missed their first outpatient appointment, and 14 (2.6%) did not complete their ROP evaluations. For each level increase in ADI, adjusted odds of missing initial follow-up increased by 17% (95% CI, 7%-28%; P < 0.001). Although race/ethnicity was associated with missed follow-up on unadjusted analyses, the apparent relationship became nonsignificant after adjusting for ADI (OR = 1.21; 95% CI, 0.51-2.88; P = 0.663).
Conclusions:
In our study cohort, patients with high ADI scores, indicating neighborhood disadvantage, were at higher risk of missed outpatient follow-up during the acute phase of ROP evaluation.
