Social Determinants Associated with Diabetic Retinopathy Awareness: National Health and Nutrition Examination Survey (2005-2008)

Abstract

PURPOSE: To identify the social determinants of health (SDH) associated with awareness of diabetic retinopathy (DR). DESIGN: Retrospective, cross-sectional study. METHODS: We identified participants with DR. Based on answers to questionnaires, those who were aware of their diagnosis were compared to those who were unaware of their diagnosis. We also compared participants with DR to participants without DR, with diabetes. Covariates included sociodemographic factors and other SDH variables identified in the National Health and Nutrition Examination Survey (NHANES) database or calculated based on literature review: depression screening (Patient Health Questionnaire 9 [PHQ-9]), social support index, food insecurity, and household crowding. The Rao–Scott χ2 test was used for categorical variables, and the T test was used for continuous variables. To identify the association between selected SDH variables and awareness of DR, we used univariate and multivariate logistic regression. RESULTS: Our NHANES analysis included participants with and without diabetes (HbA1c >6.5% or self-reported), age 40 years or older, with available fundus photography. Among the 5437 participants (weighted 107.6M) over age 40 with available fundus photography, there were 692 participants (weighted 10.3M) with diabetes and 319 participants (weighted 4.0M) with DR. Over 70% (217, weighted 3.0M) were unaware of their DR diagnosis. Among participants with DR, non-Hispanic Black participants, those born in the United States, those with US citizenship, households of 4 to 6 rooms, those interviewed in English, and those who were food insecure were more aware of their DR diagnosis. In the adjusted multivariable analysis, individuals who received food stamps in the last 6 months (AOR = 6.66, CI = 1.98-22.43) and those who were not working in the last week (AOR = 3.28, CI = 1.08-9.68) had increased odds of awareness of DR. Participants born outside of the United States had decreased odds of awareness of DR (AOR = 0.08, CI = 0.02-0.37). CONCLUSIONS: Participants experiencing adverse SDH demonstrated increased DR awareness. Interventions that address SDH may contribute to a decrease in blindness from DR by leveraging known awareness in populations at high risk.