Neighborhood-Level Social Risk Factors Associated with Presenting Glaucoma Severity at a Tertiary Eye Care Center

Abstract

Purpose : Social risk factors such as food and housing insecurity, transportation accessibility, residential inequality, and insurance access can impact eye health outcomes. These social risk factors change at a neighborhood-level depending on resource availability. We hypothesize that glaucoma patients with worse neighborhood-level social risk factors will present with more visual field (VF) loss from glaucoma.

Methods : Patients with a glaucoma diagnosis were identified from the University of Michigan’s electronic health record database, and data including demographics, address, and presenting mean deviation (MD) of the worse eye were obtained. Addresses were mapped to neighborhood-level measures of food and housing insecurity, transportation accessibility, economic inequality (Gini Index), area deprivation, socioeconomic status, and insurance access using PolicyMap and Neighborhood Atlas. Age and gender adjusted linear regression models were used to estimate the effect (β) of neighborhood-level factors on worse eye MD, and results were adjusted for multiple comparisons.

Results : 5,976 glaucoma patients were analyzed. Patients were an average of 69.3 years old (standard deviation [SD]=12.7) and 52.4% were female. Average MD in the worse eye was -8.04 decibels (SD=7.99). A 10-percentage point increase in neighborhood-level social risk factor measures was associated with significant worsening of MD, including percentage of supplemental nutrition assistance program recipients (β=-0.65, p<0.001), renters who are cost burdened (β=-0.15, p=0.003), households with no cars (β=-1.29, p<0.001), residents with Medicaid (β=-1.24, p<0.001), and residents who identified as a racial minority (β=-0.41, p<0.001). Further, worse area deprivation index (β=-0.52 per 0.1-unit increase, p<0.001), higher percentage of income spent on energy costs (β=-0.92 per 1% increase, p<0.001), worse Gini index (β=-0.47 per 0.1-unit increase, p=0.045), and lower neighborhood income (β=-0.77 per $10,000 decrease, p<0.001) were associated with significantly worse presenting MD.

Conclusions : Patients presenting to a tertiary eye care center with more VF loss from glaucoma came from neighborhoods with higher levels of poverty. Additional research is needed to untangle how personal level socioeconomic factors and neighborhood level socioeconomic factors impact presenting disease severity.

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