Association of the Social Deprivation Index With the Severity and Treatment of Diabetic Retinopathy

Abstract

Purpose: To examine the relationship between a composite measure of socioeconomic status, the Social Deprivation Index score, and the severity and treatment of diabetic retinopathy (DR). Methods: A multicenter retrospective cohort study was performed of adults with newly diagnosed DR secondary to type 1 or type 2 diabetes mellitus (DM) and at least 6 months of follow-up. Social Deprivation Index scores were calculated using patients’ zip codes. Patient demographics, baseline ocular characteristics, interventions performed, and follow-up duration were extracted from the electronic health records and the Vestrum Health database. The main outcomes were the initial and final visual acuity (VA), presence of proliferative diabetic retinopathy (PDR), tractional retinal detachment (TRD), and diabetic macular edema (DME) at presentation and during follow-up, in addition to the need for procedural intervention. Results: The study included 6781 patients. Social Deprivation Index scores corresponding to greater socioeconomic disadvantage were independently associated with an increased likelihood of the following: presenting with PDR (odds ratio [OR], 1.27, 95% CI, 1.13-1.42; P < .001) or TRD (OR, 1.76, 95% CI, 1.21-2.56; P = .003), VA at presentation ≤20/40 (OR, 1.28, 95% CI, 1.15-1.42; P < .001), ≤20/70 (OR, 1.45, 95% CI, 1.27-1.65; P < .001), and ≤20/200 (OR, 1.33, 95% CI, 1.10-1.60; P = .003), need for procedural or surgical intervention (OR, 1.20, 95% CI, 1.08-1.34; P < .001), and VA ≤20/40 (OR, 1.19, 95% CI, 11.05-1.34; P = .005) and ≤20/70 at last follow-up (OR, 1.33, 95% CI, 1.14-1.55; P < .001). Conclusions: Residing in a lower socioeconomic area is associated with greater DR severity and poorer outcomes, underscoring the need for targeted public health policies and improved outcomes for socioeconomically disadvantaged populations.