Association of Neighborhood Socioeconomic Disadvantage with Proliferative Diabetic Retinopathy.

Abstract

Purpose: To evaluate the association between neighborhood socioeconomic deprivation, distance from ophthalmology clinics, and diagnosis of proliferative diabetic retinopathy (PDR).

Design: Retrospective cohort study.

Participants: Adult patients (≥18 years) with diabetes mellitus at Johns Hopkins Hospital and University of Wisconsin-Madison.

Methods: Patient addresses were geocoded and the block group was linked to the 2021 national Area Deprivation Index (ADI). Area Deprivation Index was divided into quartiles, with higher quartiles indicating greater socioeconomic disadvantage. The distance between patient's residence and ophthalmology clinics was calculated. Multivariable logistic regression models were used to analyze the association between ADI quartile, distance from clinic, and PDR, adjusted for demographics and insurance status. The interaction between ADI and distance was tested.

Main outcome measures: Diagnosis of PDR.

Results: A total of 73 618 patients were included. A significant interaction was observed between ADI quartile and distance from ophthalmology clinics (P < 0.001). Among patients residing within 8 miles of clinics, those in higher ADI quartiles had increased odds of PDR compared with those in ADI Q1 (Q2: odds ratio [OR], 1.36; 95% confidence interval [CI], 1.12-1.65; Q3: OR, 1.79; 95% CI, 1.46-2.19; Q4: OR, 2.60; 95% CI, 2.09-3.25; P < 0.001 for trend). Conversely, for patients living more than 8 miles from clinics, the odds of PDR were similar across ADI quartiles (Q1: OR, 0.85; 95% CI, 0.73-0.98; Q2: OR, 1.02; 95% CI, 0.87-1.12; Q3: OR, 1.08; 95% CI, 0.90-1.30). However, patients in all ADI quartiles more than 8 miles had greater odds of PDR compared with those in the same ADI quartile within 8 miles (OR, 3.15; 95% CI, 2.61-3.80; OR, 1.97; 95% CI, 1.71-2.27; OR, 1.79; 95% CI, 1.51-2.12; and OR, 1.31; 95% CI, 1.07-1.61 in ADI Q1-Q4, respectively).

Conclusions: Patients living in neighborhoods with greater socioeconomic disadvantage and farther from ophthalmology clinics have greater odds of PDR. These findings suggest the potential utility of targeted interventions in socioeconomically deprived and distant areas to reduce PDR-related blindness.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.