Abstract
Purpose :
To examine the effect of neighborhood socioeconomic distress on ophthalmologic follow-up after positive screening in a diabetic teleretinal imaging (TRI) screening program.
Methods :
Included patients underwent nonmydriatic fundus imaging to screen for diabetic retinopathy at their primary care clinic between 2015-2022 and had a positive image finding that warranted referral to an ophthalmologist. We conducted a retrospective chart review to determine whether successful follow-up with an ophthalmologist was documented within one year of referral. Distressed Communities Index (DCI), a measure of neighborhood well-being based on factors like educational attainment, housing, employment, poverty, and income, was determined from patient's ZIP code. DCI scores were dichotomized into most distressed and least distressed groups. DCI and demographic characteristics were compared between patients who followed up after TRI referral and those who did not using binary logistic regression. Secondary analyses adjusted for sex, age, and race.
Results :
A total of 27,954 TRI encounters were completed for 18,454 patients, of whom 5,285 were referred for follow-up with an ophthalmologist. Forty-eight patients were excluded due to lack of ZIP code data from which to calculate DCI, for a total of 5,237 patients included in the analysis representing 355 unique ZIP codes. Mean (standard deviation) age was 63 (13) years, 2,257 (43.1%) were female, 1555 (29.7%) identified as Black, and 1,901 (36.3%) lived in a neighborhood with a DCI in the two most distressed quintiles. Overall, 2,918 (55.7%) of the total cohort of referred patients successfully completed ophthalmology follow-up. Odds of successful eyecare follow-up after screening were lower for patients living in the most distressed neighborhoods than those living in a less distressed neighborhood (998 [52.5%] versus 1920 [57.6%]; odds ratio [OR] 0.81, 95% confidence interval [CI] 0.73–0.91, p<0.001). The association between DCI and follow-up persisted in the model adjusting for age, sex, and race (adjusted OR 0.87, 95% CI 0.77–0.98, p=0.018).
Conclusions :
Diabetic patients in socioeconomically distressed neighborhoods have lower eyecare follow-up after positive TRI screening. Community-level factors must be addressed to promote diabetic retinopathy care for vulnerable populations.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.