社会健康决定因素对全国糖尿病患者眼科保健利用的影响。
The Impact of Social Determinants of Health on Eye Care Utilization in a National Sample of People with Diabetes.
机构信息
Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland.
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
出版信息
Ophthalmology. 2023 Oct;130(10):1037-1045. doi: 10.1016/j.ophtha.2023.06.007. Epub 2023 Jun 15.
PURPOSE
To evaluate the association of social determinants of health (SDoH) with eye care utilization among people with diabetes mellitus using the 2013-2017 National Health Interview Survey (NHIS).
DESIGN
Retrospective cross-sectional study.
PARTICIPANTS
Participants ≥ 18 years of age with self-reported diabetes.
METHODS
The SDoH in the following domains were used: (1) economic stability; (2) neighborhood, physical environment, and social cohesion; (3) community and social context; (4) food environment; (5) education; and (6) health care system. An aggregate SDoH score was calculated and divided into quartiles, with Q4 representing those with the highest adverse SDoH burden. Survey-weighted multivariable logistic regression models evaluated the association of SDoH quartile with eye care utilization in the preceding 12 months. A linear trend test was conducted. Domain-specific mean SDoH scores were calculated, and the performance of domain-specific models was compared using area under the curve (AUC).
MAIN OUTCOME MEASURE
Eye care utilization in the preceding 12 months.
RESULTS
Of 20 807 adults with diabetes, 43% had not used eye care. Greater adverse SDoH burden was associated with decrements in odds of eye care utilization (P < 0.001 for trend). Participants in the highest quartile of adverse SDoH burden (Q4) had a 58% lower odds (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.37-0.47) of eye care utilization than those in Q1. The domain-specific model using economic stability had the highest performing AUC (0.63; 95% CI, 0.62-0.64).
CONCLUSIONS
Among a national sample of people with diabetes, adverse SDoH were associated with decreased eye care utilization. Evaluating and intervening upon the effects of adverse SDoH may be a means by which to improve eye care utilization and prevent vision loss.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的
利用 2013-2017 年全国健康访谈调查（NHIS）评估健康社会决定因素（SDoH）与糖尿病患者眼部护理利用之间的关系。
设计
回顾性横断面研究。
参与者
年龄≥18 岁且自我报告患有糖尿病的参与者。
方法
使用以下领域的 SDoH：（1）经济稳定性；（2）邻里、物理环境和社会凝聚力；（3）社区和社会背景；（4）食品环境；（5）教育；和（6）医疗保健系统。计算了一个综合 SDoH 评分，并将其分为四分位数，其中四分位数 4 代表那些具有最高不利 SDoH 负担的人。使用调查加权多变量逻辑回归模型评估 SDoH 四分位数与前 12 个月眼部护理利用之间的关联。进行了线性趋势检验。计算了特定领域的平均 SDoH 评分，并使用曲线下面积（AUC）比较了特定领域模型的性能。
主要观察指标
前 12 个月的眼部护理利用情况。
结果
在 20807 名患有糖尿病的成年人中，有 43%的人没有使用眼部护理。不利 SDoH 负担越大，接受眼部护理的可能性就越低（趋势检验 P<0.001）。处于不利 SDoH 负担最高四分位数（Q4）的参与者接受眼部护理的可能性比处于 Q1 的参与者低 58%（优势比[OR]，0.42；95%置信区间[CI]，0.37-0.47）。使用经济稳定性的特定领域模型具有最高的 AUC（0.63；95%CI，0.62-0.64）。
结论
在全国范围内患有糖尿病的人群中，不利的 SDoH 与眼部护理利用率降低有关。评估和干预不利 SDoH 的影响可能是提高眼部护理利用率和预防视力丧失的一种手段。
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