Abstract
Purpose :
To best study how Social Determinants of Health (SDH) impact eye health within our communities, we identified individuals at two university hospitals with Diabetic Retinopathy (DR) and utilized the Distressed Communities Index (DCI) to assess the impact of SDH on disease progression for proliferative diabetic retinopathy (PDR).
Methods :
We conducted a chart abstraction at both Yale and the University of Vermont Medical Center (UVMMC) on individuals aged 18 and older diagnosed with non-proliferative diabetic retinopathy (NPDR). We identified individuals whose condition progressed to PDR. Utilizing logistic regression, we examined the impact of the DCI distress scores on the progression to PDR within each cohort. Subsequently, we merged the datasets and employed a generalized linear model to assess the relationship between progression and demographic factors.
Results :
The cohort comprised of 1,584 participants (1,354 Yale, 230 UVMMC) and both sites had equal progression rates. In the Yale cohort, associations with progression included a history of hypertension (P=0.004), age (P=0.038), insurance (P=0.01), and ethnicity (P=0.032). A 10-unit increase in DCI distress scores raised the likelihood of progression to PDR by 9% (OR [95% CI] = 1.089 [1.007, 1.178], p = 0.034). In the UVMMC cohort, the average DCI distress scores did not show significant differences (OR [95% CI] = 1.071 [0.820, 1.399], p=0.616), with nonhealing foot ulcers emerging as the only notable associated factor (P=0.032). In the combined dataset, residency in Vermont (VT) or Connecticut (CT) had no effect on progression to PDR (P = 0.778), while distress scores exhibited significance (P = 0.038) in their association with progression to PDR.
Conclusions :
The similarities in distress score effects across datasets suggests a consistent impact on outcomes, highlighting a uniform influence of distress level across samples. The state of residence did not significantly impact disease progression in this cohort. Due to UVMMC’s small sample size, combining datasets highlighted a significant link between heightened distress scores and disease progression. Future research is focused on expanding the sample size in VT to enhance our understanding of the impact of SDH on diabetic retinopathy progression, aiming to identify state-specific variations.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.