Revealing the Blind Spots: Linked EHRs Associate Racial and Ethnic Inequities in Diabetic Eye Care Testing

Area of Science:

• Ophthalmology
• Public Health
• Health Services Research

Background:

• Retinal imaging, such as fundus photography (FP) and fluorescein angiography (FA), is more sensitive for monitoring non-proliferative diabetic retinopathy (NPDR) than dilated fundus examinations.
• The influence of socioeconomic factors on the utilization of these advanced retinal imaging techniques for NPDR remains largely unexamined.

Purpose of the Study:

• To investigate the associations between various socioeconomic factors and the receipt of FP or FA in patients diagnosed with moderate to severe NPDR.
• To identify potential disparities in access to essential retinal imaging for diabetic retinopathy (DR) management.

Main Methods:

• Linking data from 16 academic electronic medical record systems across multiple sites.
• Incorporating diverse socioeconomic variables and applying Cox proportional hazards modeling.
• Analyzing data from 2,082 patients diagnosed with moderate to severe NPDR.

Main Results:

• Male patients were more likely to receive imaging than females (23.3% vs. 19.2%).
• Patients with graduate degrees received imaging more often than those with bachelor's degrees.
• Higher income quartiles (2nd-4th) showed increased imaging rates compared to the lowest quartile.
• Patients with "other/unknown" insurance had lower odds of receiving imaging (HR, 0.60).

Conclusions:

• Significant disparities in retinal imaging for DR exist based on sex, education, income, and insurance status within tertiary academic centers.
• Patients who were female, of lower socioeconomic status (income/education), or had "other/unknown" insurance were less likely to undergo recommended imaging.
• Multisite electronic health record data linkage is a viable method for studying socioeconomic impacts on DR outcomes and for population health reporting.