Abstract
Purpose :
Though associations between social determinants of health and diabetic retinopathy (DR) have been investigated, the specific impacts of loneliness, social support, and stress are currently not well understood. This cross-sectional study aimed to test whether high loneliness, low social support, and high perceived stress were each associated with DR in the National Institutes of Health All of Us (AoU) Research Program.
Methods :
The study population included all AoU participants with diabetes mellitus (DM) who answered survey questions related to themes of loneliness, social support, and stress in AoU. Participants were included if they answered at least half of the surveys in at least one of the three themes. The outcome of interest was the presence of DR based on the International Classification of Diseases, 9th and 10th Revision codes. The exposures were levels of loneliness, social support, and perceived stress based on scores calculated from survey responses using a modified UCLA Loneliness Scale, modified RAND Medical Outcomes Study (MOS) Social Support Survey score, and the Perceived Stress Scale, respectively. Participants were categorized by score as low or high loneliness; low or high support; and low, moderate, or high perceived stress. Study covariates included age, race and ethnicity, sex at birth, income, level of education, smoking, hypertension, body mass index, and most recent A1c. Multivariable logistic regression was used to examine associations between levels of loneliness, social support, and perceived stress and DR, adjusting for covariates.
Results :
Overall, 10,397 participants were included. Of the participants, there were 1,091 (10.5%) with DR; 4,707 (45.3%) with high loneliness; 1,627 (15.8%) with low support; and 3,875 (37.8%) and 601 (5.9%) with moderate and high perceived stress, respectively. Compared to low loneliness, high loneliness was associated with increased odds of DR (adjusted odds ratio [aOR]: 1.22, 95% confidence interval [CI]: 1.05-1.42, p = 0.011). There were no significant associations between social support or perceived stress levels and DR.
Conclusions :
The results suggest loneliness may be associated with increased likelihood of DR in individuals with DM. Future studies should examine DM control, rates of DR screening, and DR severity in individuals with loneliness.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.