Impact of Socioeconomic Disadvantage and Diabetic Retinopathy Severity on Poor Ophthalmic Follow-Up in a Rural Vermont and New York Population

Figures & data

Table 1 Demographic Characteristics

	Poor Follow-Up (n=68)[95% CI]^a,b
Overall (n=331)	20.5% [16.5–25.3]
Gender
Female (n=148)	20.9% [15.0–26.7]
Male (n=183)	20.2% [15.1–28.3]
Race
White (n=309)	20.1% [16.0–24.9]
Non-white (n=20)	30.0% [14.1–52.8]
Disadvantaged Status^c
Yes (n=70)	30.0% [20.4–41.7]
No (n=261)	18.0% [13.8–23.1]
Age (Mean 63.7 ± 12.5) Quartiles
<57 (n=83)	26.5% [18.1–37.0]
57–65 (n=94)	18.1% [11.5–27.2]
66–72 (n=72)	20.1% [12.9–31.8]
>72 (n=82)	17.1% [10.3–26.8]
Diabetic Retinopathy Severity
1. None (n=178)	27.0% [20.9–34.0]
2. Mild (n=25)	20.0% [8.5–40.1]
3. Moderate (n=61)	11.5% [5.6–22.2]
4. Severe (n=8)	12.5% [1.7–53.9]
5. Proliferative (n=59)	11.9% [5.7–22.9]
Diabetic Macular Edema
Yes (n=55)	5.5% [18.9–28.9]
No (n=276)	23.5% [18.8–28.9]

Notes: ^aPoor Follow-up defined as no visit within double the recommended follow-up interval. ^bOf 68 People with poor follow-up, 57 did not follow-up at all within the study window. ^cDisadvantaged = Medicaid, Medicare/Medicaid.

Figure 1 Study flowchart.

Table 2 Predictors of Poor Follow-Up

	Overall (n=331)	Good Follow-Up^b (n=263)	Poor Follow-Up (n=68)	Odds Ratio (95% CI)	Univariable P-value
Disadvantaged^a	21.1%	18.6%	30.9%	1.95 (1.07–3.56)	0.03
Median Age (Interquartile Range)	65 (16)	65 (16)	60.5 (18.5)	0.83 (0.67–1.03)^c	0.09
Gender (% female)	44.7%	44.5%	45.6%	1.04 (0.61–1.79)	0.87
Race (% white)	93.9%	94.6%	91.2%	0.59 (0.22–1.59)	0.29
Diabetic Retinopathy Severity (Mean^d)	1.2 (mild)	1.4 (>mild)	0.7 (<mild)	0.38 (0.20–0.70)^e	0.002
Macular Edema Present	16.6%	19.8%	4.4%	0.19 (0.057–0.62)	0.006
Prescribed Follow-up in Days (Mean±SD)	236 (±144)	228 (±147)	267 (±126)	1.06 (1.00–1.13)^f	0.046

Notes: ^aDisadvantaged = Medicaid, Medicare/Medicaid. ^bGood follow-up defined as completed visit within less than double recommended follow-up interval. ^cPer decade of age. ^dDiabetic retinopathy severity on 5-point scale (see Table 1). ^eModerate or more severe retinopathy as compared to mild or no retinopathy. ^fPer 30 days.

Table 3 Comparison of Patients by Disadvantaged Status

	Disadvantaged Status^b (n=70)	Not Disadvantaged Status (n=261)
Poor Follow-Up^a	30.0%	18.0%
Median Age (Interquartile Range)	59 (17)	66 (15)
Diabetic Retinopathy Severity (Mean)^c	1.0	1.3
Macular Edema Present?	15.7%	16.9%

Notes: ^aPoor Follow-up defined as no visit within double the recommended follow-up interval. ^bDisadvantaged = Medicaid, Medicare/Medicaid. ^cSeverity on 5-point scale (see Table 1).