Akinyemi Oluwasegun A, Jones Md Leslie S, Ochoa Alejandro, Nelson Luke, Weldeslase Terhas A, Yousuf Salman J
The Clive O. Callender, M.D., Howard-Harvard Health Sciences Outcomes Research Center, Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
Department of Ophthalmology, Howard University College of Medicine, Washington, DC, USA.
J Vitreoretin Dis. 2024 Feb 26;8(3):293-298. doi: 10.1177/24741264241234132. eCollection 2024 May-Jun.
To investigate the association between neighborhood-level socioeconomic factors, quantified by the Distressed Communities Index, and emergency department visits for diabetic retinopathy (DR). All patients who presented to the emergency department for DR in California were analyzed using the State Emergency Department Database (2018-2020). Patients were stratified by Distressed Communities Index score and DR severity. Logistic regression was applied to explore the independent correlation between Distressed Communities Index scores and proliferative DR (PDR). Of 2 725 195 emergency department visits for diabetic patients, Distressed Communities Index data were available for 2 459 577 (90.3%); 39 693 were for DR, including 13 617 (34.3%) for PDR. Hispanics (44.2%) were the largest racial/ethnic group to present for PDR, followed by non-Hispanic Whites (19.6%) and non-Hispanic Blacks (19.3%). A significant association was observed between the Distressed Communities Index and emergency department visits for PDR, with distressed neighborhoods having the highest incidence (adjusted odds ratio [aOR], 1.63; 95% CI, 1.20-2.23; = .001). Other predictors included Hispanic ethnicity (aOR, 2.21; 95% CI, 1.97-2.48; < .001) and Black race (aOR, 1.46; 95% CI, 1.28-1.67; < .001) compared with White race and having Medicaid (aOR, 1.37; 95% CI, 1.13-1.65; = .001) compared with private insurance. The Distressed Communities Index identified patients residing in the most distressed neighborhoods as being at the highest risk for presenting to the emergency department for PDR based on 7 socioeconomic factors. Policymakers may consider the Distressed Communities Index as a tool for targeting DR prevention strategies and improving healthcare accessibility.
研究由困境社区指数量化的社区层面社会经济因素与糖尿病视网膜病变（DR）急诊就诊之间的关联。利用加利福尼亚州急诊数据库（2018 - 2020年）对所有因DR前往急诊室就诊的患者进行分析。患者按困境社区指数得分和DR严重程度分层。应用逻辑回归来探讨困境社区指数得分与增殖性DR（PDR）之间的独立相关性。在2725195次糖尿病患者急诊就诊中，有2459577次（90.3%）可获取困境社区指数数据；其中39693次是因DR就诊，包括13617次（34.3%）因PDR就诊。西班牙裔（44.2%）是因PDR就诊的最大种族/族裔群体，其次是非西班牙裔白人（19.6%）和非西班牙裔黑人（19.3%）。观察到困境社区指数与PDR急诊就诊之间存在显著关联，困境社区的发病率最高（调整优势比[aOR]，1.63；95%置信区间[CI]，1.20 - 2.23；P = 0.001）。其他预测因素包括与白人种族相比，西班牙裔种族（aOR，2.21；95% CI，1.97 - 2.48；P < 0.001）和黑人种族（aOR，1.46；95% CI，1.28 - 1.67；P < 0.001），以及与私人保险相比，拥有医疗补助（aOR，1.37；95% CI，1.13 - 1.65；P = 0.001）。困境社区指数基于7个社会经济因素确定居住在最困境社区的患者因PDR前往急诊室就诊的风险最高。政策制定者可将困境社区指数视为一种工具，用于确定DR预防策略的目标并改善医疗可及性。
