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OBJECTIVE: To evaluate the long-term impact of social determinants of health on diabetic retinopathy (DR) incidence, complications, and management in patients with type 2 diabetes mellitus (T2DM), with emphasis on disparities among treatment-adherent individuals and demographic subgroups. METHODS: We conducted a retrospective cohort study using TriNetX, a national electronic health records network spanning 70 U.S. healthcare organisations. Adults diagnosed with T2DM were categorised into socially deprived and non-deprived cohorts based on ICD-10 codes related to housing instability, food insecurity, and financial hardship. Propensity score matching balanced cohorts on demographics, comorbidities, laboratory values, medications, and ophthalmic care utilisation. Outcomes included incident DR, sight-threatening complications, ophthalmic treatment and diagnostics, and documented treatment nonadherence. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: Matched cohorts included 62,786 socially deprived and 62,786 non-deprived patients (mean age, 54 years; 42% female; 49% White, 27% Black, 14% Hispanic). Over a 10-year follow-up, social deprivation was associated with increased risk of DR (HR 1.40, 95% CI 1.34-1.47) and sight-threatening complications, including blindness. Documented nonadherence was significantly increased in the socially deprived cohort (HR 3.57, 95% CI 3.47-3.68). Among patients without documented nonadherence, social deprivation was associated with increased DR risk (HR 1.44, 95% CI 1.35-1.54) and treatment utilisation. Disparities were most pronounced in males, Hispanic individuals, and adults aged 18-39. CONCLUSIONS: Social deprivation, regardless of documented treatment adherence, increased DR incidence and complications. Targeted interventions are needed to address persistent disparities and reduce DR burden.
Hong et al. (Wed,) studied this question.