Insights into Inequity: Exploring the Impact of Socioeconomic Disparities on Timely Outpatient Follow-Up Care for Infants Screened for Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness in the US. While timely screening and treatment can prevent most vision loss from ROP, socioeconomic factors such as poverty, low health literacy, and lack of transportation often impede access to crucial follow-up care after hospital discharge. However, there is limited research studying the relationship between socioeconomic factors and access to outpatient ROP care. This retrospective chart review study examines the relationship between various measures of socioeconomic status and adherence to recommended outpatient ROP screening among infants at Duke Eye Center. We will conduct an analysis on the two categories of variables: (1) patient-level data (race/ethnicity, language spoken, need for interpretation services, health insurance, and geographic accessibility to the clinic) and (2) area-level socioeconomic indicators (neighborhood disadvantage indices, rural/urban county designations, and property values) to examine whether there is an association between these factors and timely outpatient follow-up care. We found that having public health insurance was a significance risk factor for outpatient follow-up non-adherence among infants with ROP. Other significant variables include greater gestational age and longer follow-up instructions. Non-English speakers were more likely to follow up on time compared to English speakers. Lack of transportation was qualitatively observed as a common barrier to timely follow-up. By elucidating the socioeconomic forces that may disproportionately limit access to ROP care among vulnerable populations, our study has implications for guiding future advocacy and policy efforts to target specific social determinants and alleviate barriers to care.