Neighborhood Poverty and Clinic Attendance in the Michigan Screening and Intervention for Glaucoma and Eye Health Through Telemedicine Program.

Abstract

Prcis: Higher neighborhood-level poverty is associated with greater odds of missing a free eye disease screening appointment, underscoring the importance of community-based interventions to address upstream social determinants of health.

Purpose: To investigate the association between neighborhood-level characteristics and attendance for a free eye disease screening.

Methods: The MI-SIGHT program is conducted in 2 community clinics in Southeastern Michigan. Participant-level demographics were extracted from electronic health records. Neighborhood-level characteristics, including Area Deprivation Index (ADI), median household income (HHI), percent of households with >30% rent burden, percent of households without vehicles, percent of households in subsidized housing, and energy burden, were obtained from the Wisconsin Neighborhood Atlas and the United States census. Logistic regression was used to model the probability of clinic visit attendance, which was the main outcome measure.

Results: One thousand four hundred thirty-one participants were scheduled for screening appointments between July 2020 and November 2021, with a no-show rate of 23%. Individuals lived an average of 7.7 miles from each clinic (SD=8.1) and in neighborhoods with a mean ADI of 6.8 (SD=3.2, 1-10 scale, where 10 is the most deprived). After adjusting for age, sex, race, and ethnicity, participants from neighborhoods with higher deprivation were more likely to have missed clinic visits. For example, there was an 8% higher odds of missed clinic visits for every 1-point increase in ADI (odds ratio, OR=1.08, P =0.020) and an 18% higher odds of a missed visit with every 10% increase in households without a vehicle (OR=1.18, P =0.013).

Conclusions: Higher neighborhood-level poverty was associated with greater odds of missing a free eye disease screening appointment after adjusting for individual characteristics. Increased neighborhood-level resources are likely needed to bolster engagement in preventive eye care.