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Diabetic Retinopathy Outcomes Among Unhoused Individuals: A Big Data Analysis
Ahmed M Alshaikhsalama1, Ahmed Abdi1, Tushar Talapathy2
1Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA.
Retina (Philadelphia, Pa.)
|June 9, 2026
Summary
Unhoused individuals with diabetes experience more severe diabetic retinopathy (DR) and vision-threatening complications. Addressing homelessness is crucial for improving DR outcomes and eye care.
Area of Science:
- Ophthalmology
- Public Health
- Health Disparities
Background:
- Diabetic retinopathy (DR) is a leading cause of blindness.
- Access to consistent healthcare is vital for managing diabetes and preventing DR complications.
- Homelessness presents significant barriers to healthcare access and management of chronic conditions like diabetes.
Purpose of the Study:
- To compare diabetic retinopathy (DR) severity, vision-threatening complications (VTCs), treatment patterns, and longitudinal outcomes between unhoused individuals and stably housed individuals with diabetes.
- To identify the impact of unhoused status on DR progression and treatment adherence.
Main Methods:
- Retrospective analysis of electronic health records from a large multicenter network.
- Stratification of patients with type 1 or type 2 diabetes based on unhoused status using ICD-10 codes.
- Propensity score-matched analysis to compare outcomes at one year, including incident complications and treatments, using multivariate Cox regression.
Main Results:
- Unhoused patients presented with significantly higher rates of proliferative diabetic retinopathy (PDR), vitreous hemorrhage (VH), and tractional retinal detachment (TRD).
- Unhoused individuals had reduced follow-up rates (30.3% vs 55.2%).
- One-year follow-up revealed increased risks of VH, diabetic macular edema (DME), and PDR in unhoused individuals, with unhoused status independently increasing PDR risk (HR, 1.55).
Conclusions:
- Unhoused individuals exhibit more advanced diabetic retinopathy and higher rates of vision-threatening complications at presentation.
- Unhoused status is a significant determinant of poor DR outcomes, necessitating targeted screening and integrated care models.
- Socially informed ophthalmic care is essential to address the unique needs of unhoused populations with diabetes.
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