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Oluyemi O Olumolade, Matheos Yosef, Shokoufeh Khalatbari, Anjali Shah; Association of Socioeconomic Variables with Risk Factors for Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1103.
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© ARVO (1962-2015); The Authors (2016-present)
Little is known about the impact of socioeconomic factors on outcomes in patients with diabetic retinopathy. Studies have suggested that factors such as income, race and ethnicity can influence health outcomes. This retrospective observational study evaluates the association of factors such as race, ethnicity, income level and payor with risk factors for diabetic retinopathy, such as hemoglobin A1c (HbA1c), blood pressure (BP), and body mass index (BMI).
Analysis of longitudinal electronic health record data was obtained via the Comprehensive Diabetic Retinopathy Program. 3,470 patients with 11,437 visits to the Kellogg Eye Center retina clinic between 2016 and 2018 were included. Patients with a diagnosis of diabetes were included. Zip codes were used to determine income level based on publically available median household income values. Lower and higher quartiles were designated as low and high income and the middle two quartiles represented medium income. Univariable and multivariable longitudinal analyses were conducted evaluating the effects of age, race, ethnicity, income level, and payor on HbA1c, systolic BP, and BMI.
HbA1c was significantly lower with increased age (p<0.001), white (p<0.001) and mixed/unknown (p=0.002) race (vs. black). Ethnicity, income level and payor were not significantly associated with HbA1c. Higher systolic BP was significantly associated with low income (vs high income, p=0.007 and medium income, p=0.01), and Medicaid (p=0.03) and Medicare (p=0.003) payors (vs Blue Cross Blue Shield). Lower systolic BP was significantly associated with white (P<0.001) and mixed/unknown races (p<0.001) (vs. black) as well as non-Hispanic ethnicity (p<0.001) (vs. Hispanic.) Patients from low income zip codes were found to have a higher BMI than those from medium and high incomes (p=0.001, p=0.02, respectively). Unknown/mixed race (vs. black) had significantly lower BMI (p<0.0001), but no statistically significant differences between blacks and whites were noted.
This retrospective multivariable analysis on patients with diabetes presenting to an academic retina clinic demonstrates an association of race, ethnicity, income level and payor with multiple risk factors that directly impact outcomes in diabetic retinopathy. Further study is needed to better understand the complex interaction of socioeconomic disparities and clinical factors on health outcomes.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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