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James Liu, Jessica Kuo, Vikram Shankar, Kumar Rao, Todd P Margolis, Emily Fondahn, Rithwick Rajagopal; Socioeconomic Influences on Screening Rates for Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1894.
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Diabetic retinopathy (DR) is one of the leading causes of new-onset blindness. Though all adults with diabetes require annual ophthalmic screening at minimum, only about 50% are compliant with this guideline and such rates are even lower among poorer patients. This raises the hypothesis that several socioeconomic barriers exist that affect compliance with DR screening recommendations. Here, we reviewed data from a large academic center serving a sizable indigent patient population to test this hypothesis.
We performed a retrospective study of adults with diabetes seen over a 12-month period at the Barnes Jewish Hospital Primary Care Medicine Clinic (PCMC). Demographic information was recorded during the patient's primary care visit. ZIP Code Tabulation Areas (ZCTA) data based off the U.S. Census Bureau was used as a proxy for patient income levels. A patient was considered compliant if a screening eye exam had been performed within the previous year. Logistic regression and chi-squared analysis was used to identify any factors that significantly correlated with patient compliance.
3058 adults with diabetes were included. Their overall compliance rate with ophthalmic screening was 31.2%. This rate was not significantly associated with age, gender, race, or education level, but was significantly correlated to insurance category (p < 0.001). Patients with HMO, PPO, or self-pay plans had lower compliance (20.1%, 25.0% and 14.8%, respectively) compared to Medicare patients (37.1%). Those with a higher approximated income level also had better compliance when stratified by insurance. Medicaid, PPO, and self-pay patients were significantly more compliant (OR = 1.38, 4.69, and 2.79, respectively) with their annual diabetic eye exams if their associated ZCTA median income was above average.
Poor compliance in DR screening continues to be a significant problem. Insurance status and income levels may be relevant contributors. In our study, Medicare patients and those living in higher income neighborhoods demonstrated greater adherence towards screening recommendations. Further studies to determine why these factors alter behavior and compliance are needed. By better understanding these potential socioeconomic barriers, new technologies and screening paradigms can be designed to lower costs and increase accessibility of preventative care to those who are at high risk for vision loss from diabetes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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