Risk Factors and Social Determinants of Health for Retinal Artery Occlusion in the National Institutes of Health All of Us Program

BACKGROUND: Previous studies have identified inequities in stroke epidemiology. Given retinal artery occlusion (RAO) is a stroke equivalent, we investigated risk factors and social determinants of health (SDOH) associated with RAO. METHODS: This was a retrospective case-control study. The case group consisted of all patients diagnosed with RAO in the National Institutes of Health All of Us database from November 1992 to November 2020. The control group consisted of all patients without a diagnosis of RAO during that time frame. Associations of predictors of RAO were estimated using logistic regression models. RESULTS: There were 384 patients with an RAO diagnosis and 328,639 participants in the non-RAO group. Median age at RAO diagnosis was 66 years (interquartile range [IQR] 57-72). Median age at study was 74 years (IQR 67-81) for the RAO group and 58 years (IQR 42-69) for the control group. Age- and sex-adjusted multivariable analysis revealed factors positively associated with RAO, including older age {odds ratio [OR]: 2.19 (95% confidence interval [CI]: 2.01-2.39), P < 0.001}, male sex (OR: 1.54 [95% CI: 1.25-1.89], P < 0.001), Black race (OR: 1.62 [95% CI: 1.24-2.09], P < 0.001), military/Veterans Affairs insurance (OR: 2.44 [95% CI: 1.61-3.66], P < 0.001), and Medicaid (OR: 1.51 [95% CI: 1.06-2.15], P = 0.022). Having a college/advanced degree (OR: 0.76 [95% CI: 0.59-0.98], P = 0.031), annual household income between $50,000 and $100,000 (OR: 0.72 [95% CI: 0.52-0.98], P = 0.035), and annual household income between $100,000 and $200,000 (OR: 0.48 [95% CI: 0.32-0.70], P < 0.001) were protective against RAO. CONCLUSIONS: These findings confirm previously described associations between RAO and cardiovascular comorbidities and identified novel associations between RAO and SDOH, including Black race and Medicaid insurance. Stroke risk around the time of RAO was high in this cohort.