A comparison of pediatric and adult ocular diseases in the context of social determinants of health

Abstract

Purpose

Little is known about the impact of social determinants of health (SDoH) on pediatric eye health outcomes and the relative results in comparison to adults. SDoH encompass social, economic, and environmental factors that influence health outcomes, including access to healthcare, education, income, housing, and neighborhood safety. The objective of this study is to compare pediatric and adult ocular diseases and examine the prevalence of SDoH components among participants of the National Institutes of Health All of Us Research (AoU) Program.

Design

The NIH AoU Program, which is a U.S. based initiative, recruited diverse participants via partnerships with multiple organizations, prioritizing underrepresented groups. We included participants in the NIH AoU Research Program with data who answered the survey question pertaining to delayed care due to lack of transportation, food insecurity, income level, insurance status, and access to eye care within the last 12 months.

Methods

The main outcome was a diagnosis or prevalence of glaucoma, cataract, age-related macular degeneration (AMD), diabetic retinopathy (DR), which were grouped into adult eye diseases, and Coats disease, amblyopia, strabismus, retinoblastoma, and retinopathy of prematurity (ROP), which were grouped into pediatric eye diseases. The exposure was self-reported delays in care for medical appointments due to limitations in transportation, insurance status, income level and food insecurity. The prevalence of SoDH components were compared between pediatric and adult patients. Multivariable models were used for analysis.

Results

The study population included 834,237 participants with 22,729 adult participants with ocular diseases and 6340 pediatric patients with ocular diseases. Pediatric ocular diseases had a mean age of 50.3 (±10.4), while adult diseases were 72.9 (±10.2) years (p < 0.001). ROP diagnosis demonstrated the highest rate of lack of insurance, income levels, food insecurity, and lack of transportation access across all ocular diseases. Those with pediatric conditions showed significantly greater food insecurity, low-income levels, and lack of insurance status compared to adults (p < 0.001, respectively). For both pediatric and adult conditions, as disease severity increased, so did the lack of transportation (p < 0.001).

Conclusions

Pediatric ocular diseases were associated with greater deficits in social determinants of health. In all groups, as disease severity increased, so did the difficulties in accessing care.