Sophia Y. Wang, MD, MS
Credit: LinkedIn
A national study of people affected type 2 diabetes (T2DM) in the United States revealed complex barriers to seeing an eye care professional for diabetic retinopathy screening, with factors related to social determinants of health and socioeconomic status.1
The study, including nearly 12,000 participants with T2D, found that factors associated with eye care in the previous 12 months included higher education level, higher income and insurance status, while that food insecurity and housing insecurity were associated with not receiving eye care during the same time period. .
“Our findings highlight self-reported barriers to seeking care and the potential importance of taking steps to promote health equity, such as providing a safe space to receive care, reducing implicit bias, and improving health care. “access to care,” wrote the investigative team, led by Sophia Y. Wang, MD, MS, of the Department of Ophthalmology at Byers Eye Institute, Stanford University.
Screening guidelines, including those from the American Academy of Ophthalmology (AAO), recommend that patients with T2DM undergo annual screening for diabetic retinopathy upon diagnosis.2 Previous research has shown the association between various socioeconomic variables and lower adherence to diabetic retinopathy screening, but few have elaborated the patient perspective to understand the reason for this association.
In this analysis, Wang and colleagues assessed differences in demographics, overall health, and social determinants of health between patients with T2DM who did or did not report a visit to an eye care professional for diabetic retinopathy screening. .1 The All of Us Research Database includes detailed health information from ≥250,000 people across the United States and self-reported survey data. It focuses on capturing a diverse patient population, including groups traditionally underrepresented in medicine, to better understand health disparities.
The study used the All of Us version 7 cohort, the most recent version, which included data on participants aged ≥18 years enrolled from May 2018 to July 2022. The primary endpoint was self-reported visit of patients to an ophthalmologist, including an optometrist, ophthalmologist, or ophthalmologist, within the past 12 months. The main variables included information from various surveys, measuring social determinants of health, health knowledge, race and ethnicity, and income.
Among the 11,551 analyzed participants with T2DM, 7,983 (69%) reported visiting an ophthalmologist in the past year. The data revealed that the overall average age of participants was 65 years, 6,301 (54.55%) were cisgender women, and 4,456 patients (39%) reported a household income less than $50,000. Survey data revealed that most measures differed significantly between patients who did or did not report a visit to an eye care professional.
After analysis, investigators found that people who were food insecure or housing insecure were less likely to see an ophthalmologist than those who were financially stable (food insecurity: adjusted odds ratio (aOR), 0.75 ( 95% CI, 0.61 – 0.91; housing insecurity: aOR, 0.86 (95% CI, 0.75 – 0.98). Those with fair mental health were also less likely to consult an ophthalmologist (aOR, 0.84; 95% CI, 0.56 – 0.96) compared to those with good mental health.
The analysis also revealed that factors related to a participant’s attitude toward practitioner concordance were associated with not having seen an ophthalmologist. Those who thought practitioner agreement on race/ethnicity, gender, language, or religion was somewhat or very important were less likely to see an ophthalmologist (aOR, 0.83 (95% CI, 0 .74 – 0.93); aOR, 0.85 (95% CI, 0.76 – 0.95), respectively).
A shared identity between patient and physician has been associated with a higher quality patient experience and could lead to potentially improved outcomes. Wang and colleagues noted that this could be due to a patient’s trust in their clinician, due to commonalities that can improve relationships between patients and doctors.
“Our results demonstrated the importance of practitioner concordance in eye care delay, suggesting the potential importance of improving workforce diversity and implementing cultural competency training to bridge the gap. gap between patient-physician discordance,” the investigators wrote.
The references
- Younessi DN, Lin JC, Janetos TM. Regulatory and information gaps in the over-the-counter eye care industry: Over-the-counter, under the radar. JAMA Ophthalmol. Published online November 2, 2023. doi:10.1001/jamaophthalmol.2023.4961
- Flaxel CJ, Adelman RA, Bailey ST, et al. Diabetic Retinopathy Preferred Practice Pattern® (published correction appears in Ophthalmology. 2020 Sep;127(9):1279). Ophthalmology. 2020;127(1):P66-P145. doi:10.1016/j.ophtha.2019.09.025
