June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Social Determinants of Health in Diabetic Retinopathy in the US: Evidence from the National Health and Nutrition Examination Survey (2005-2008)
Author Affiliations & Notes
  • Kristen Harris Nwanyanwu
    Yale University, New Haven, Connecticut, United States
  • Joana Andoh
    Yale University, New Haven, Connecticut, United States
  • Evan Chen
    Yale University, New Haven, Connecticut, United States
  • Yunshan Xu
    Yale University, New Haven, Connecticut, United States
  • Yanhong Deng
    Yale University, New Haven, Connecticut, United States
  • Footnotes
    Commercial Relationships   Kristen Nwanyanwu, None; Joana Andoh, None; Evan Chen, None; Yunshan Xu, None; Yanhong Deng, None
  • Footnotes
    Support  National Eye Institute Career Development Award 1 K23 EY030530-01, Yale Diabetes Research Center P30 DK045735, Unrestricted Research to Prevent Blindness
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1135. doi:
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      Kristen Harris Nwanyanwu, Joana Andoh, Evan Chen, Yunshan Xu, Yanhong Deng; Social Determinants of Health in Diabetic Retinopathy in the US: Evidence from the National Health and Nutrition Examination Survey (2005-2008). Invest. Ophthalmol. Vis. Sci. 2021;62(8):1135.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Diabetic retinopathy (DR) is a leading cause of preventable blindness. According to Healthy People 2020, five key areas of social determinants of health (SDH) are: social and community context (which includes racial discrimination), education, economic stability, neighborhood and the built environment, and health and healthcare. This study defines a novel set of variables formulated from the National Health and Nutrition Examination Survey (NHANES) and identifies the SDH associated with DR.

Methods : Our NHANES analysis included participants with and without diabetes (HbA1c>6.5% or self-reported), ages 40 years or older with available fundus photography. We compared those with DR to participants with diabetes without DR. We also compared those with DR to the rest of the cohort. Covariates included sociodemographic factors and other SDH variables identified or calculated based on literature review: Depression screening (PHQ-9), Social Support Index, Food Insecurity, and Household crowding. Rao-Scott Chi-Square test was used for categorical variables and t-test was used for continuous variables, with consideration of the survey design.

Results : Among the total 5,399 (weighted 107.6M) participants over age 40 with fundus photography, there were 315 (weighted 4.0M) participants with DR and 692 (weighted 10.3M) participants with diabetes (Table 1). Among those with diabetes, DR was more prevalent in Black, Mexican-American, and Other Hispanic participants (p=0.0022). There were no other statistically significant differences in the SDH between those with DR and those with diabetes without DR. When compared to the entire cohort without DR (Table 2), DR was more prevalent in these sociodemographic categories: Black, Mexican-American, and Other Hispanic participants, born in Mexico, less formal education, lower household income (all p<0.05). DR was also more prevalent in these other SDH variables: Spanish primary language, food insecurity, no routine place for healthcare, fewer rooms in homes, fewer close friends, and higher depression scores (all p<0.05).

Conclusions : Among participants with diabetes, racial discrimination was the only SDH more prevalent DR. SDH variables were more prevalent in participants with DR compared to the overall population. Interventions that include SDH modification may contribute to a decrease in blindness from DR.

This is a 2021 ARVO Annual Meeting abstract.

 

 

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