Social determinants of health impacting adherence to diabetic retinopathy examinations
Introduction This study evaluates the association of multidimensional social determinants of health (SDoH) with non-adherence to diabetic retinopathy examinations.Research design and methods This was a post-hoc subgroup analysis of adults with diabetes in a prospective cohort study of enrollees in t...
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e002374.full |
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| author | Cindy X Cai Melissa L McCarthy Yixuan Li Scott L Zeger |
| author_facet | Cindy X Cai Melissa L McCarthy Yixuan Li Scott L Zeger |
| author_sort | Cindy X Cai |
| collection | DOAJ |
| description | Introduction This study evaluates the association of multidimensional social determinants of health (SDoH) with non-adherence to diabetic retinopathy examinations.Research design and methods This was a post-hoc subgroup analysis of adults with diabetes in a prospective cohort study of enrollees in the Washington, DC Medicaid program. At study enrollment, participants were given a comprehensive SDoH survey based on the WHO SDoH model. Adherence to recommended dilated diabetic retinopathy examinations, as determined by qualifying Current Procedural Terminology codes in the insurance claims, was defined as having at least one eye examination in the 2-year period following study enrollment.Results Of the 8943 participants enrolled in the prospective study, 1492 (64% female, 91% non-Hispanic Black) were included in this post-hoc subgroup analysis. 47.7% (n=712) were adherent to the recommended biennial diabetic eye examinations. Not having a regular provider (eg, a primary care physician) and having poor housing conditions (eg, overcrowded, inadequate heating) were associated with decreased odds of adherence to diabetic eye examinations (0.45 (95% CI 0.31 to 0.64) and 0.70 (95% CI 0.53 to 0.94), respectively) in the multivariate logistic regression analysis controlling for age, sex, race/ethnicity, overall health status using the Chronic Disability Payment System, diabetes severity using the Diabetes Complications Severity Index, history of eye disease, and history of diabetic eye disease treatment.Conclusions A multidimensional evaluation of SDoH revealed barriers that impact adherence to diabetic retinopathy examinations. Having poor housing conditions and not having a regular provider were associated with poor adherence. A brief SDoH assessment could be incorporated into routine clinical care to identify social risks and connect patients with the necessary resources to improve adherence to diabetic retinopathy examinations. |
| format | Article |
| id | doaj-art-bd6989ccd8474d71bf871423f13de1d8 |
| institution | DOAJ |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-bd6989ccd8474d71bf871423f13de1d82025-08-20T02:39:28ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2021-002374Social determinants of health impacting adherence to diabetic retinopathy examinationsCindy X Cai0Melissa L McCarthy1Yixuan Li2Scott L Zeger32 Ophthalmology, Duke Medicine, Durham, North Carolina, USADepartment of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USADeutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Shanghai, GermanyBiostatistics, Johns Hopkins University, Baltimore, Maryland, USAIntroduction This study evaluates the association of multidimensional social determinants of health (SDoH) with non-adherence to diabetic retinopathy examinations.Research design and methods This was a post-hoc subgroup analysis of adults with diabetes in a prospective cohort study of enrollees in the Washington, DC Medicaid program. At study enrollment, participants were given a comprehensive SDoH survey based on the WHO SDoH model. Adherence to recommended dilated diabetic retinopathy examinations, as determined by qualifying Current Procedural Terminology codes in the insurance claims, was defined as having at least one eye examination in the 2-year period following study enrollment.Results Of the 8943 participants enrolled in the prospective study, 1492 (64% female, 91% non-Hispanic Black) were included in this post-hoc subgroup analysis. 47.7% (n=712) were adherent to the recommended biennial diabetic eye examinations. Not having a regular provider (eg, a primary care physician) and having poor housing conditions (eg, overcrowded, inadequate heating) were associated with decreased odds of adherence to diabetic eye examinations (0.45 (95% CI 0.31 to 0.64) and 0.70 (95% CI 0.53 to 0.94), respectively) in the multivariate logistic regression analysis controlling for age, sex, race/ethnicity, overall health status using the Chronic Disability Payment System, diabetes severity using the Diabetes Complications Severity Index, history of eye disease, and history of diabetic eye disease treatment.Conclusions A multidimensional evaluation of SDoH revealed barriers that impact adherence to diabetic retinopathy examinations. Having poor housing conditions and not having a regular provider were associated with poor adherence. A brief SDoH assessment could be incorporated into routine clinical care to identify social risks and connect patients with the necessary resources to improve adherence to diabetic retinopathy examinations.https://drc.bmj.com/content/9/1/e002374.full |
| spellingShingle | Cindy X Cai Melissa L McCarthy Yixuan Li Scott L Zeger Social determinants of health impacting adherence to diabetic retinopathy examinations BMJ Open Diabetes Research & Care |
| title | Social determinants of health impacting adherence to diabetic retinopathy examinations |
| title_full | Social determinants of health impacting adherence to diabetic retinopathy examinations |
| title_fullStr | Social determinants of health impacting adherence to diabetic retinopathy examinations |
| title_full_unstemmed | Social determinants of health impacting adherence to diabetic retinopathy examinations |
| title_short | Social determinants of health impacting adherence to diabetic retinopathy examinations |
| title_sort | social determinants of health impacting adherence to diabetic retinopathy examinations |
| url | https://drc.bmj.com/content/9/1/e002374.full |
| work_keys_str_mv | AT cindyxcai socialdeterminantsofhealthimpactingadherencetodiabeticretinopathyexaminations AT melissalmccarthy socialdeterminantsofhealthimpactingadherencetodiabeticretinopathyexaminations AT yixuanli socialdeterminantsofhealthimpactingadherencetodiabeticretinopathyexaminations AT scottlzeger socialdeterminantsofhealthimpactingadherencetodiabeticretinopathyexaminations |