Biologics Use Disparities in Non-Infectious Uveitis: A National Study of Social Determinants of Health

To determine whether insurance status, household income, race, sex, or age influence receipt of biologic therapy among U.S. patients with non-infectious uveitis.

We analyzed NIH All of Us data (2005-2022) in a nationwide retrospective cohort study. Patients were identified by ICD-9, ICD-10, and SNOMED codes. Multivariable logistic regression tested associations between race, sex at birth, income, insurance, and age and the primary outcome of biologic use. Individuals with missing data were retained as separate strata. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were calculated.

Out of 2911 patients, 244 (8.4%) received biologics. Treatment proportions varied across demographic and socioeconomic strata. The strongest predictor of reduced biologic use was uninsured status (OR 0.23, CI: 0.037-0.728). Income below $35K (OR 0.55, CI: 0.367-0.812) and $35K-$50K (OR 0.46, CI: 0.237-0.840) were also associated with lower biologic use. Participants with missing household income data also demonstrated lower odds of receiving biologic therapy. African American and Hispanic patients demonstrated decreased odds of receiving biologics (OR 0.58, CI: 0.399-0.839; OR 0.66, CI: 0.434-0.989). Females were more likely to receive biologics (OR 1.46, CI: 1.089-1.962). Each incremental year in age exhibited decreased odds of biologics treatment (OR 0.97, p < 0.001).

Access to biologic therapy for non-infectious uveitis varies by insurance, income, race, sex, and age. Insurance coverage exerted the greatest effect, indicating that payer policy is the main determinant of overall treatment allocation in the U.S. healthcare system.