Socioeconomic associations of amblyopia in the All of Us research program.

Purpose: To identify potential socioeconomic associations of amblyopia in a nationwide cohort.

Methods: This is a retrospective, case-control study of participants in the All of Us Research Program. Cases were defined as adults 18-64 years of age with a diagnosis of amblyopia who answered the "Basics" survey questions of interest. Age-, sex-, and race-matched controls with no amblyopia diagnosis were sampled at a 4:1 control-to-case ratio. Univariate and multivariable testing was performed to determine socioeconomic associations of amblyopia, with P values of <0.05 considered statistically significant.

Results: Of 1,714 patients with a diagnosis of amblyopia, 859 fell within the defined age range. Amblyopic participants were more likely to be of Black or African American (25.8% vs 21.8% [P = 0.004]) or Hispanic race/ethnicity (25.6% vs 22.6% [P = 0.04]) and were significantly older (50.0 vs 46.6 years [P < 0.0001]) than unmatched controls. After applying additional inclusion criteria limiting analysis to those with socioeconomic data available, a restricted set of 601 amblyopic participants were compared to 2,404 age-, sex-, and race/ethnicity-matched controls. Comparing cases and matched controls, participants with a diagnosis of amblyopia were significantly more likely to be unemployed (47.8% vs 39.3% [P = 0.0002]), non-home-owners (61.4% vs 55.8 % [P = 0.01]), have Medicaid insurance (33.8% vs 26.2% [P = 0.0002]), or have a household income under $35,000 annually (50.2% vs. 43.2% [P = 0.002]). Multivariable analysis revealed that amblyopic participants were significantly more likely to be unemployed (OR = 1.56; 95% CI, 1.25-1.94; P = 0.00006) and more likely to have Medicaid insurance (OR = 1.43; 95% CI, 1.13-1.82; P = 0.003).

Conclusions: There are potential long-term socioeconomic associations of amblyopia. Given reported differences in both screening rates and treatment outcomes based on race, ethnicity, and income level, it is vital that future studies adequately portray the diversity of the population through broad, representative recruitment.