Madlock-Brown Charisse, Lee Austin, Seltzer Jaime, Solomonides Anthony, Mathews Nisha, Phuong Jimmy, Weiskopf Nicole, Adams William G, Lehmann Harold, Espinoza Juan
Acute and Critical Care Division, College of Nursing, University of Iowa, 50 Newton Rd, Iowa City, IA, 52242, USA.
Department of Computer Science, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, USA.
BMC Public Health. 2025 Jul 19;25(1):2508. doi: 10.1186/s12889-025-23606-2.
This research delves into the confluence of racial disparities and health inequities among individuals with disabilities, with a focus on those contending with both diabetes and visual impairment.
Utilizing data from the TriNetX Research Network, which includes electronic medical records of roughly 115 million patients from 83 anonymous healthcare organizations, this study employs a directed acyclic graph (DAG) to pinpoint confounders and augment interpretation. We identified people with visual impairments using ICD-10 codes, deliberately excluding diabetes-related ophthalmology complications. Our approach involved multiple race-stratified analyses, comparing co-morbidities like chronic pulmonary disease in visually impaired patients against their counterparts. We assessed healthcare access disparities by examining the frequency of annual visits, instances of two or more A1c measurements, and glomerular filtration rate (GFR) measurements. Additionally, we evaluated diabetes outcomes by comparing the risk ratio of uncontrolled diabetes (A1c > 9.0) and chronic kidney disease in patients with and without visual impairments.
The prevalence of diabetes was nearly doubled in individuals with visual impairments across White, Asian, and African American populations. Higher rates of chronic kidney disease were observed in visually impaired individuals, with a risk ratio of 1.731 for African Americans, 2.252 for White, and non-significant for the Asian group. A statistically significant difference in the risk ratio for uncontrolled diabetes was found only in the White cohort with one GFR reading (1.042). White individuals without visual impairments were less likely to receive an A1C test or a GFR test, while African American individuals with visual impairment were more likely to get both. Differences in testing were not significant for the Asian population.
This study uncovers pronounced disparities in diabetes prevalence and management among individuals with visual impairments who seek care, particularly among White and African American groups. Our DAG analysis illuminates the intricate interplay between SDoH, healthcare access, and frequency of crucial diabetes monitoring practices, highlighting visual impairment as both a medical and social issue.
本研究深入探讨了残疾人群体中种族差异与健康不平等的交汇点，重点关注同时患有糖尿病和视力障碍的人群。
利用TriNetX研究网络的数据，该网络包含来自83个匿名医疗保健组织的约1.15亿患者的电子病历，本研究采用有向无环图（DAG）来确定混杂因素并增强解释力。我们使用ICD - 10编码识别视力障碍患者，特意排除与糖尿病相关的眼科并发症。我们的方法包括多次按种族分层分析，将视力障碍患者的慢性肺病等合并症与其对应人群进行比较。我们通过检查年度就诊频率、两次或更多次糖化血红蛋白（A1c）测量实例以及肾小球滤过率（GFR）测量情况来评估医疗保健获取差异。此外，我们通过比较有和没有视力障碍的患者中未控制的糖尿病（A1c＞9.0）和慢性肾病的风险比来评估糖尿病结局。
在白人、亚洲人和非裔美国人中，视力障碍者的糖尿病患病率几乎翻倍。视力障碍者中慢性肾病的发生率较高，非裔美国人的风险比为1.731，白人为2.252，亚洲组无显著差异。仅在有一次GFR读数的白人队列中，未控制糖尿病的风险比存在统计学显著差异（1.042）。没有视力障碍的白人接受A1C测试或GFR测试的可能性较小，而有视力障碍的非裔美国人接受这两种测试的可能性较大。亚洲人群的测试差异不显著。
本研究揭示了寻求医疗护理的视力障碍者在糖尿病患病率和管理方面存在明显差异，尤其是在白人和非裔美国人群体中。我们的DAG分析阐明了健康的社会决定因素（SDoH）、医疗保健获取与关键糖尿病监测实践频率之间的复杂相互作用，突出了视力障碍既是一个医学问题也是一个社会问题。
