Evaluating the Relationship between Neighborhood-Level Social Vulnerability and Patient Adherence to Ophthalmology Appointments

ABSTRACT

Purpose

To examine the association between neighborhood-level social vulnerability and adherence to scheduled ophthalmology appointments.

Methods

In this retrospective cohort study, records of all patients ≥18 years scheduled for an ophthalmology appointment between September 12, 2020, and February 8, 2021, were reviewed. Primary exposure is neighborhood-level Social Vulnerability Index (SVI) based on the patient’s residential location. SVI is a rank score of 15 social factors into four themes (socioeconomic status, household composition/disability, minority status/language, and housing type/transportation), ranging from 0 to 1.0, with higher ranks indicating greater social vulnerability. The overall SVI score and each theme were analyzed separately as the primary exposure of interest in multivariable logistic regression models that controlled for age, sex, appointment status (new or established), race, and distance from clinic. The primary outcome, non-adherence, was defined as missing more than 25% of scheduled appointments.

Results

Of 8,322 patients (41% non-Hispanic Black, 24% Hispanic, 22% non-Hispanic White) with scheduled appointments, 28% were non-adherent. Non-adherence was associated with greater social vulnerability (adjusted odds ratio [aOR] per 0.01 increase in overall SVI = 2.46 [95% confidence interval, 1.99, 3.06]) and each SVI theme (socioeconomic status: aOR = 2.38 [1.94, 2.91]; household composition/disability: aOR = = 1.51 [1.26, 1.81]; minority status/language: aOR = 2.03 [1.55, 2.68]; housing type/transportation: aOR = 1.41 [1.16, 1.73]).

Conclusion

Neighborhood-level social vulnerability is associated with greater risk of non-adherence to scheduled ophthalmology appointments, controlling for individual characteristics. Multi-level intervention strategies that incorporate neighborhood-level vulnerabilities are needed to reduce disparities in access to ophthalmology care.

KEYWORDS:

• Access
• adherence
• health equity
• social vulnerability index
• social vulnerability

Acknowledgments

The authors thank the Center for Health Equity Research (CHER) Chicago for their invaluable collaboration.

Disclosure statement

Dr. R.V. Paul Chan discloses the following 1) Alcon; 2) Novartis; 3) Phoenix (Unpaid SAB). Dr. Krishnan reports research funding from the National Institutes of Health, the Patient Centered Outcomes Research Institute, the American Lung Association, Regeneron, and consulting fees from GlaxoSmithKline, AstraZeneca, and Bdata, Inc. Dr. Hallak discloses the following: AbbVie (Employment).

The following authors have no financial disclosures: Dr. Angelica C. Scanzera, Sasha Kravets, Hugh Musick. Dr. Sage J. Kim. All authors attest that they meet the current ICMJE criteria for authorship.

An earlier version of this manuscript was submitted as a pre-print to MedRxiv. This submission is not simultaneously being considered for any other publication.

Disclaimer statement

The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Eye Institute; the National Institute on Minority Health and Health Disparities; the National Institutes of Health.

Financial support

This work was supported by funding by NIH/NEI K12 EY021475 (Scanzera), NIH/NEI P30 EY001792, NIH/NIMHD U54MD012523 (Kim, Scanzera), NIH/NIMHD R01MD014839 (Kim) and an unrestricted grant to the Department of Ophthalmology and Visual Sciences from Research to Prevent Blindness. The funding organizations had no role in the design or conduct of this research.

Additional information

Funding

This work was supported by the National Eye Institute [K12 EY021475,P30 EY001792]; National Institute on Minority Health and Health Disparities [U54MD012523].