The Spectrum of Visual Impairment and Eye Pathology in a Population Experiencing Housing Insecurity

Abstract

Purpose : Prior studies have shown that housing insecurity may be correlated with increased visual morbidity. This study investigated the prevalence of eye diseases among the homeless and/or housing insecure (H/HI) population who received ophthalmic care at the Zuckerberg San Francisco General Hospital and its affiliated San Francisco Department of Public Health (SFDPH) clinics. A secondary aim was to determine if the prevalence of the most common eye diagnoses is associated with race/ethnicity to identify health disparities.

Methods : We conducted a data extraction from electronic medical records of all visits to the ophthalmology and optometry clinics at SFDPH between 01/01/2014 – 02/12/2023 from adults (≥18 years) classified as H/HI based on the International Classification of Diseases codes, address listing, or indication of housing insecurity during any visit. Population characteristics were summarized descriptively. Chi-squared tests determined if there was an association between race/ethnicity and each of the three most common eye diagnoses. Statistical analyses were performed on R.

Results : In our sample of 4,741 unique patients, the top three eye diagnoses were refractive error (70.3%), type 2 diabetes with mild to moderate non-proliferative diabetic retinopathy without macular edema (NPDR w/o ME) (44.3%), and cataract (33.7%) (Table 1). We then categorized these eye diagnoses according to race/ethnicity (Table 2). Refractive error prevalence was similar across all groups (p=0.64). For NPDR w/o ME, Native Hawaiian/Other Pacific Islander, Asian, and Black/African American groups had the highest prevalence (p<0.001). The prevalence of cataract was highest in the Asian (47.5%), Black/African American (34.5%), and White (33.3%) groups (p<0.001). Ethnicity was significantly associated with NPDR w/o ME (p<0.05) and cataract (p<0.001).

Conclusions : Our findings suggest a high prevalence of eye pathology and visual impairment among H/HI individuals. We also found higher prevalence of diabetic retinopathy and cataract among certain racial/ethnic groups. We anticipate that the findings from our study will guide eye clinic providers and staff in prioritizing and addressing the most pressing eye diseases more effectively and equitably among the H/HI population.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Individuals can have more than one diagnosis.

 

Chi-squared tests were used to calculate the p-values.