Proliferative Diabetic Retinopathy Disproportionately Impacts Distressed Communities Near a Northeastern Academic Center

Purpose

To identify the associations between social determinants of health (SDoH) and the progression of proliferative diabetic retinopathy (PDR).

Design

Secondary analysis of a retrospective cohort study.

Participants

We extracted data from electronic medical records of individuals at the Yale Eye Center or Dana Eye Clinic, ages ≥18 years, who had a documented diagnosis of nonproliferative diabetic retinopathy (NPDR) at their first recorded (index) ophthalmology visit within the study period.

Methods

We identified participants with NPDR whose disease progressed to PDR during the study time period. We assigned Distressed Communities Index (DCI) scores using participants’ zip codes and created a visualized geographic distribution of scores using ArcGIS. We assessed differences in sociodemographic and health characteristics between participants whose disease progressed to PDR and those whose disease did not progress using 2-sample t tests, chi-square, and Fisher exact tests where appropriate. We used logistic regression to assess the associations between SDoH and progression to PDR. We conducted a time-to-event analysis using Cox proportional hazards regression, adjusting for relevant confounders.

Main Outcome Measures

The primary outcome was the progression from NPDR to PDR.

Results

Among the 1354 participants, 137 (10%) developed PDR within the study's 7-year period. Of the 137, 54% were male, 46% were aged ≥65 years, 35% identified as White or Caucasian, and 34% identified as Black or African American. Those whose disease progressed to PDR had significantly worse DCI scores compared to those whose disease did not progress (mean [standard deviation 64 (26) vs. 58 (27), P = 0.015). Unadjusted logistic regression revealed a significant association between DCI and progression to PDR (P = 0.037), whereas the adjusted model did not (P = 0.124).

Conclusions

Participants with disease progression to PDR were more likely to live in disadvantaged areas. Using socioeconomic data and geographic mapping to identify high-risk populations may help health care professionals implement early screening and provide better resources for those at risk of retinal disease progression.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.