Socioeconomics, insurance strong factors in diabetic eye disease, visual acuity
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Public insurance, less education and health care access and resources contribute to risk of developing diabetic eye disease complications, according to results presented at the virtual American Academy of Ophthalmology annual meeting.
The retrospective study also showed a strong correlation of complications in diabetic macular edema (DME) influenced by health care accessibility, racial and social factors and disease burden.
“There’s a greater risk of diabetes mellitus and its complications in certain subsets of the population, and those patients with public insurance, less education, and poor access to health care and resources are at the greatest risk of developing these complications,” Rishi Singh, MD, staff surgeon at Cleveland Clinic Cole Eye Institute, associate professor of ophthalmology at Lerner College of Medicine, told Healio. “In fact, the National Health and Nutritional Survey evaluated this, and found that non-Hispanic, African-American individuals were more likely to have diabetic retinopathy complications than non-Hispanic Caucasian individuals as part of the survey.”
The study consisted of 203,000 treatment-naive patients diagnosed with DME who had received a minimum of one anti-VEGF injection prior to selection. Of the selected patients, baseline vision was at 66.1 ETDRS letters and the majority were Southern US residents (n = 86,013) with private insurance (n = 65,749). The majority of patients (n = 101,599) were found to have proliferative diabetic retinopathy at the time of diagnosis.
Hispanic ethnicity and Medicaid insurance were found to be the strongest factors associated with worsening visual acuity, while non-Hispanic ethnicity, private insurance and Caucasian race correlated with a higher rate of anti-VEGF injections over a 12-month period, according to Singh.
“This actually is in line with some previous studies which have looked at health care disparities in our US populations,” Singh said. “We conducted a similar analysis of patients with the Cole Eye Institute in Cleveland, Ohio prior to conducting this study, and found very, very similar outcomes with regards to these disparities seen. While we think that the natural history of diabetic macular edema is influenced by glycemic control, the time since diabetes diagnosis and ophthalmic interventions, we have begun to realize that it’s far more complex than that.”
The study suggests Hispanic ethnicity and Medicaid insurance are the strongest associated factors for worsening visual acuity, with non-Hispanic demographics and private insurance correlated with a higher anti-VEGF injection number and long-term visual acuity.
“For future steps, we hope to look at improving physician understanding of the social determinants of health and barriers to care to improve the development of treatment plans that are appropriate for patients. We also would like to analyze education, smoking status, distance to clinics and racial and ethnic biases in healthcare settings, as well as in the settings of antibiotic utilization, and to understand the opportunities for improving access to regular anti-VEGF injections for these populations most at risk. Finally, it’s important to characterize literacy amongst patient populations,” Singh told Healio.
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Malhotra, N. et al. Association of racial and social factors in diabetic macular edema. Presented at: American Academy of Ophthalmology annual meeting; Nov. 13-15, 2020 (virtual meeting).
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