Social Determinants of Diabetic Retinopathy Severity at Initial Presentation: A Cross-Sectional Study of Data from an...

Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults in the US We aimed to assess relationships between social determinants of health and indicators of DR severity at initial presentation at a public safety net hospital.

We conducted a cross-sectional study using electronic health records among patients presenting to Zuckerberg San Francisco General (ZSFG) with diabetic retinopathy. Outcomes included DR severity (non-proliferative vs proliferative) and visual acuity (VA) at initial presentation. Multivariable modified Poisson and linear regressions were used to assess the relationship between sociodemographic and clinical predictors and these outcomes.

We identified 2044 patients with DR at initial presentation to (1851 with complete VA data) who had a mean (SD) age was 55.8 (11.6) years. Two hundred eighty (13.7%) patients had proliferative DR at initial presentation to ZSFG and 449 (24.3%) had some level of visual impairment or blindness (logMAR ≥ 0.30). Predictors increasing the risk of severe DR included experiencing housing or economic problems (adjusted Risk Ratio (aRR) 1.35, 95% CI 1.0 to 1.71, P=0.01), other race and ethnicity (aRR 1.94, 95% CI 1.06 to 3.54, p=0.03), former smoking status (aRR 1.28, 95% CI 1.00 to 1.64, P=0.05). Predictors associated with worse visual acuity at presentation included Medicare (adjusted Mean Difference (aMD) 0.05 logMAR, 95% CI 0.01 to 0.10) and Medicaid (aMD 0.06 logMAR, 95% CI 0.01 to 0.10, P =0.01) insurance status, hypertension (aMD 0.03 logMAR, 95% CI 0.002 to 0.06, P =0.04), age (aMD 0.02 logMAR, 95% CI 0.00 to 0.03, p=0.01), and Cantonese language (aMD 0.04 logMAR, 95% CI 0.00 to 0.09, p=0.05).

Given the high burden of severe DR and vision loss in this population, identifying approaches to target high-risk groups with early diagnosis and treatment among vulnerable populations is needed.