Study shows economically disadvantaged patients are more likely to delay treatment for severe retinal detachment

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Researchers conducting a retrospective cohort study found that patients with neighborhood-level social determinants of health (SDOH) were more likely to present with severe rhegmatogenous retinal detachment (RRD).

According to the researchers, the study suggests these patients were more likely to delay treatment as a result of their socioeconomic position.¹

The study was conducted at a tertiary care academic center and included 700 patients, residence in neighborhoods with worse socioeconomic deprivation and higher percentage of workers who drove to work were associated with increased odds of presenting with visual acuity worse than 20/40 and fovea-involving RRD, even after adjusting for multiple individual characteristics.

“Adverse neighborhood-level SDOH were associated with more severe RRD at presentation, supporting the possibility that some neighborhoods may benefit from policy change or other interventions to promote vision saving care in RRD,” the researchers wrote.

The researchers pointed out in the study that functional outcomes following the repair of RRDs often depend on baseline visual acuity and foveal status. The adverse social determinants of health can result in hurdles to timely presentation for repair and limit vision outcomes.¹

The researchers set out to examine the link between neighborhood-level SDOH with baseline severity (visual acuity and fovea status) of RRD. They conducted a retrospective cohort study that included adult patients 18 years and older who underwent primary repair of uncomplicated RRD at the Wilmer Eye Institute from January 2008 to December 2018. Study data were analyzed from December 2023 to April 2024.¹

In the study, researchers matched the census block group of patient home addresses to multiple neighborhood-level SDOH. including the Area Deprivation Index (ADI), per capita income, percentage of renters, percentage of rent burden, percentage of people using a food assistance program, percentage of uninsured individuals, their mode of transportation to and from work, how far they live from public transportation, traffic density, neighborhood walkability, as well as the Index of Medical Underservice score, and aggregate cost of medical care.¹

Researchers found the odds of presenting with vision worse than 20/40 or fovea-involving RRD using multivariable logistic regression adjusting for age, sex, race and ethnicity, and insurance.

In the study, a total of 700 patients (mean age, 57.9 [12.4] years; 432 male [61.7%]) were included. Each decile increase in ADI, indicating more socioeconomic disadvantage, was linked with an increased odds of presenting with worse visual acuity and fovea-involving RRD (odds ratio [OR], 1.14; 95% CI, 1.04-1.24; P = .004 and OR, 1.13; 95% CI, 1.04-1.22; P = .005, respectively).1

Moreover, each $1000 increase in per capita income was associated with lower odds of presenting with worse vision (OR, 0.99; 95% CI, 0.98-0.99; P = .001). Every 1% increase in the percentage of workers who drove to work was associated with an increased odds of presenting with worse vision and fovea-involving RRD (OR, 1.02; 95% CI, 1.01-1.03; P = .005 and OR, 1.01; 95% CI, 1.00-1.03; P = .04, respectively).¹

The researchers noted the study was limited by its focus on a single center in an urban environment and a lack of diversity among patients involved in the study.

The researchers concluded that the results of this cohort study suggest that patients with a residence in neighborhoods with more socioeconomic deprivation or a higher percentage of workers who drove to work were more likely to present with more severe RRD even after accounting for multiple individual-level characteristics.

“These findings support consideration of public policy changes to address the barriers faced by patients residing in certain neighborhoods who seek prompt surgical intervention for RRD to reduce health disparities in RRD outcomes,” they concluded in the study.

Reference:

1. Ong SS, Tran D, Westlund E, et al. Neighborhood-Level Social Determinants of Health and Presenting Characteristics for Rhegmatogenous Retinal Detachments. JAMA Ophthalmol. Published online August 08, 2024. Accessed August 9, 2024. doi:10.1001/jamaophthalmol.2024.2889