Persistent disparities in diabetic retinopathy outcomes among socially deprived individuals despite treatment adherence.

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.