Association of Eye Care Utilization and Social Determinants of Health Among Patients with Non-Infectious Uveitis: A Cross-Sectional Factor Analysis of the All of Us Research Cohort.

PURPOSE: To evaluate the association between social determinants of health (SDOH) and eye care utilization among individuals with noninfectious uveitis (NIU) in the United States, using a large national database.

METHODS

We performed a retrospective cross-sectional study with de-identified data from the All of Us Research Program. Adults with ≥2 ICD-9/10 codes for NIU at least 6 months apart were included. Eye care utilization within the past year was assessed using the Healthcare Access and Utilization survey. Sociodemographic and SDOH data were obtained from respective surveys. An exploratory factor analysis identified latent SDOH constructs, and modified Poisson regression assessed associations with utilization.

RESULTS

Among 4,311 participants (2,127 with utilization data), 81.3% reported eye care use within the past year. Two latent SDOH factors were identified: (Factor 1) Psychosocial adversity (loneliness, perceived discrimination, stress, neighborhood disorder, low social support), and (Factor 2) Structural hardship (food insecurity, transportation difficulty, low educational attainment, provider concordance concerns, limited health literacy). In multivariable analysis, structural hardship was significantly associated with lower eye care utilization (RR = 0.952, 95% CI: 0.913-0.992). Male sex was also associated with reduced utilization (RR = 0.949, 95% CI: 0.904-0.995), whereas older age showed a modest positive association (RR = 1.005 per year, 95% CI: 1.003-1.007).

CONCLUSIONS

Structural SDOH barriers were associated with reduced eye care utilization among individuals with NIU. Food insecurity, transportation difficulty, limited health literacy, and lower educational attainment are potential key modifiable barriers and warrant further investigation.