Social Determinants of Health in Uveitis: A Literature Review.

Abstract

Background: The uveitides are a group of intraocular inflammatory diseases which can lead to blindness without treatment. It has been shown that socioeconomic status, health literacy, and access to healthcare play a pivotal role in the prevalence, severity, and treatment outcomes in ophthalmic conditions. We review the current literature on the impact of social determinants of health (SDoH) in patients with uveitis.

Methods: A systematic literature search was conducted utilizing PubMed, Google Scholar, and Embase databases in July 2024. Inclusion criteria included studies written in English, focusing on SDoH in patients with uveitis using the following keywords: "uveitis," "social determinants of health," "socioeconomic status," "education," "access to healthcare," "health literacy," "health disparities," "race/ethnicity," "gender," and "environmental factors." Case reports were excluded.

Results: Fifty two articles were included. Among these, 31 addressed healthcare access (e.g. limited specialist availability, cost/insurance barriers, urban-rural gaps), 23 highlighted economic stability (e.g. low income, out-of-pocket costs, poor medication adherence), 19 discussed environment and community (e.g. higher infectious uveitis rates in resource-limited areas, lack of social support), 18 focused on racial and ethnic disparities (e.g. advanced disease at presentation, worse outcomes for African American, Hispanic, and Indigenous populations), and 15 addressed education and awareness (e.g. low health literacy, inadequate patient education materials). Nine papers examined two domains, and 10 incorporated three or more. Across domains, limited resources and knowledge were associated with delayed diagnosis, suboptimal adherence, and poorer visual outcomes.

Conclusion: The current literature shows a correlation between SDoH and an increased incidence and poorer disease outcomes in patients with uveitis. Further research is needed to mitigate disparities in care for patients with uveitis.