Hicks Patrice M, Lu Ming-Chen, Woodward Maria A, Niziol Leslie M, Darnley-Fisch Deborah, Heisler Michele, Resnicow Kenneth, Musch David C, Mitchell Jamie, Mehdipanah Roshanak, Imami Nauman R, Newman-Casey Paula Anne
Department of Ophthalmology and Visual Sciences, School of Medicine, University of Michigan, Ann Arbor, Michigan.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
Ophthalmol Sci. 2024 Aug 22;5(1):100598. doi: 10.1016/j.xops.2024.100598. eCollection 2025 Jan-Feb.
The neighborhood and built environment social determinant of health domain has several social risk factors (SRFs) that are modifiable through policy efforts. We investigated the impact of neighborhood-level SRFs on presenting glaucoma severity at a tertiary eye care center.
A cross-sectional study from August 2012 to May 2022 in the University of Michigan electronic health record (EHR).
Patients with a diagnosis of any open-angle glaucoma with ≥1 eye care visit at the University of Michigan Kellogg Eye Center and ≥1 reliable visual field (VF).
Participants who met inclusion criteria were identified by International Classification of Diseases ninth and tenth revision codes (365.x/H40.x). Data extracted from the EHR included patient demographics, address, presenting mean deviation (MD), and VF reliability. Addresses were mapped to SRF measures at the census tract, block group, and county levels. Multilevel linear regression models were used to estimate the fixed effects of each SRF on MD, after adjusting for patient-level demographic factors and a random effect for neighborhood. Interactions between each SRF measure with patient-level race and Medicaid status were tested for an additive effect on MD.
The main outcome measure was the effect of SRF on presenting MD.
In total, 4428 patients were included in the analysis who were, on average, 70.3 years old (standard deviation = 11.9), 52.6% self-identified as female, 75.8% self-identified as White race, and 8.9% had Medicaid. The median value of presenting MD was -4.94 decibels (dB) (interquartile range = -11.45 to -2.07 dB). Neighborhood differences accounted for 4.4% of the variability in presenting MD. Neighborhood-level measures, including worse area deprivation (estimate, β = -0.31 per 1-unit increase; < 0.001), increased segregation (β = -0.92 per 0.1-unit increase in Theil's H index; < 0.001), and increased neighborhood Medicaid (β = -0.68; < 0.001) were associated with worse presenting MD. Significant interaction effects with race and Medicaid status were found in several neighborhood-level SRF measures.
Although patients' neighborhood SRF measures accounted for a minority of the variability in presenting MD, most neighborhood-level SRFs are modifiable and were associated with clinically meaningful differences in presenting MD. Policies that aim to reduce neighborhood inequities by addressing allocation of resources could have lasting impacts on vision outcomes.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
健康领域的邻里和建成环境社会决定因素包含若干可通过政策措施加以改变的社会风险因素（SRF）。我们调查了邻里层面的社会风险因素对一家三级眼科护理中心青光眼就诊严重程度的影响。
2012年8月至2022年5月在密歇根大学电子健康记录（EHR）中进行的一项横断面研究。
在密歇根大学凯洛格眼科中心被诊断患有任何开角型青光眼且至少有1次眼科护理就诊记录和至少1次可靠视野（VF）检查的患者。
通过国际疾病分类第九版和第十版编码（365.x/H40.x）确定符合纳入标准的参与者。从电子健康记录中提取的数据包括患者人口统计学信息、地址、就诊时的平均偏差（MD）和视野可靠性。地址被映射到普查区、街区组和县层面的社会风险因素测量指标。在调整了患者层面的人口统计学因素和邻里层面的随机效应后，使用多水平线性回归模型估计每个社会风险因素对平均偏差的固定效应。测试了每个社会风险因素测量指标与患者层面种族和医疗补助状态之间的相互作用对平均偏差的累加效应。
主要结局指标是社会风险因素对就诊时平均偏差的影响。
总共4428名患者纳入分析，他们的平均年龄为70.3岁（标准差=11.9），52.6%自我认定为女性，75.8%自我认定为白人，8.9%有医疗补助。就诊时平均偏差的中位数为-4.94分贝（dB）（四分位间距=-11.45至-2.07 dB）。邻里差异占就诊时平均偏差变异性的4.4%。邻里层面的测量指标，包括更差的地区贫困程度（估计值，β=-0.31，每增加1个单位；P<0.001）、更高的隔离程度（β=-0.92，泰尔H指数每增加0.1个单位；P<0.001）以及更高的邻里医疗补助比例（β=-0.68；P<0.001）与更差的就诊时平均偏差相关。在几个邻里层面的社会风险因素测量指标中发现了与种族和医疗补助状态的显著交互作用。
虽然患者的邻里社会风险因素测量指标仅占就诊时平均偏差变异性的一小部分，但大多数邻里层面的社会风险因素是可改变的，并且与就诊时平均偏差的临床显著差异相关。旨在通过解决资源分配问题来减少邻里不平等的政策可能会对视力结果产生持久影响。
本文末尾的脚注和披露中可能包含专有或商业披露信息。
