The Relationship between Unstable Housing, Food Insecurity and Vision Status in the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) Program

Abstract

Purpose : Individuals with unstable housing and food insecurity may have difficulty accessing eyecare resources which can impact vision outcomes. When basic needs are unmet, it is more challenging to focus on one’s health. This study aims to evaluate the relationship between these two social risk factors and vision status.

Methods : Participants from the first year MI-SIGHT cohort were analyzed (Newman-Casey et al. 2021). Participants completed surveys that included socio-demographic information and assessment of housing and food security. Ophthalmic technicians obtained participants’ presenting visual acuity (PVA) with a Snellen chart. Three vision outcomes were assessed, including: 1. PVA for the better eye, 2. visual impairment (VI, PVA of better eye ≤20/50), 3. uncorrected or under-corrected refractive error (UURE, PVA ≤20/50 and best corrected VA ≥20/40). Participant characteristics were summarized and compared between groups using 2-sample t-, Chi-square, and Fisher’s exact tests. The association of food and housing security with PVA was evaluated by linear regression and the associations with VI and UURE by logistic regression.

Results : The 1165 participants were on average 55 years old (standard deviation [SD]=14.5), 62% female, 54% Black, and 10% Latinx. 50% reported <$20k of annual household income and 20% reported no medical insurance. PVA for the better eye was on average 0.12 LogMAR units (SD=0.19; Snellen=20/26±1.9 lines). VI and UURE were identified in 10.3% and 8.3% of participants, respectively. 28.9% of participants reported food insecurity, 3.4% reported unstable housing, and 2.2% both. In the age-adjusted models, while food insecurity was not associated with vision status, unstable housing was significantly associated with worse PVA (estimate=0.15 [Snellen=1.5 lines], 95% confidence interval [CI]=0.09-0.21, p<0.001), higher odds of VI (odds ratio [OR]=3.54, 95% CI=1.59-7.33, p=0.001) and higher odds of UURE (OR=3.74, 95% CI=1.62-7.92, p=0.001).

Conclusions : Unstable housing has a large impact on vision outcomes. Public health policy initiatives are needed to support those with social risk factors such as unstable housing that impact a myriad of health conditions.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.