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Cited by 29Health disparities and outcomesRetinal Diseases and TreatmentsCultural Competency in Health Care

Racial Disparities in Barriers to Care for Patients With Diabetic Retinopathy in a Nationwide Cohort

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Huang, Bonnie B., Radha Saseendrakumar, Bharanidharan, Delavar, Arash, Baxter, Sally L.·2023·Translational Vision Science & Technology
DOI 10.1167/tvst.12.3.14PMC PMC10029769
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Abstract

Purpose: To ascertain specific barriers of care among patients with diabetic retinopathy (DR) from different racial/ethnic groups. Methods: In this cross-sectional study, we included adult participants in the National Institutes of Health All of Us Research Program with DR who answered questions in the Healthcare Access & Utilization survey and Social Determinants of Health (SDoH) survey. Logistic regression was used to study the association between barriers to care and race/ethnicity. Results: Our cohort included 885 DR patients who answered the Healthcare Access & Utilization survey and 385 DR patients who responded to the SDoH survey. After adjusting for confounders, Hispanic individuals were more likely than non-Hispanic White individuals to report delaying getting medical care due to not being able to get child care (odds ratio [OR] = 6.57 [95% confidence interval {CI}, 1.67-27.8]). Furthermore, compared to non-Hispanic White individuals, non-Hispanic Black individuals were significantly more likely to report being treated with less respect (OR = 2.62 [95% CI, 1.15-5.80]), treated with less courtesy (OR = 2.51 [95% CI, 1.01-5.92]), and receive poorer service than other people (OR = 2.85 [95% CI, 1.25-6.34]) when they go to a doctor's office or other healthcare provider. Conclusions: We found that Hispanic and non-Hispanic Black individuals with DR reported greater delays/barriers to care compared to non-Hispanic White individuals even after controlling for individualized socioeconomic factors. Translational Relevance: This study highlights the importance of taking steps to promote health equity, such as increasing access to child care resources and reducing implicit bias among eye care providers, to increase access to care and prevent vision loss from DR.

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  • African-American patients who do undergo screening are more likely to present with more severe forms of DR.

    “For African-American patients who do undergo screening, they are more likely to present with more severe forms of DR8.”

    From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [8]

    The Introduction reports lower screening adherence among Black patients and a greater risk of DR-related visual impairment, but neither establishes the severity of DR when patients present for screening. The Results examine barriers to care rather than DR severity at screening; searches for severity and presentation at screening found no passage addressing the claim. (LLM, conf=0.73)

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Authors
Huang, B. B., Radha Saseendrakumar, B., Delavar, A., & Baxter, S. L.
Affiliations
  • Northwestern University (US)
  • Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
  • University of California San Diego (US)
Corresponding author
Baxter, Sally L.
ORCID
Venue
Translational Vision Science & Technology
Publisher
Association for Research in Vision and Ophthalmology (ARVO)
Published
2023-03-16
Volume
12
Issue
3
Pages
14
ISSN
2164-2591 (ISSN-L)
DOI
10.1167/tvst.12.3.14
PMC
PMC10029769
OpenAlex
W4327574136
Cited by
29
References
6
Citations by year
2026: 10 · 2025: 7 · 2024: 10 · 2023: 2
FWCI
7.84
Type
journal article
Language
en
Open access
Licence
Locations
  • Translational Vision Science & Technology (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • Research to Prevent Blindness (1 U24 OD023163, 3 OT2 OD023206, P30EY022589, 1 OT2 OD026555, HHSN 263201600085U, U24 OD023176, AOD 16037, 1 OT2 OD025276, 3 OT2 OD023205, 1 OT2 OD025277, 1 U24 OD023121)
  • National Institutes of Health (DP5OD029610, OT2OD026557, OT2OD025277, AOD 16037, HHSN263201600085U, OT2OD025315, OT2OD025337, U24OD023121, OT2OD023205, OT2OD026556, U24OD023176, OT2OD026549, OT2OD026553, OT2OD026555, U2COD023196, OT2OD026554, OT2OD026550, OT2OD026548, OT2OD026551, U24OD023163, 263201600085U, OT2OD026552, OT2OD023206, OT2OD025276)
  • National Eye Institute (P30EY022589)
  • National Institute of Diabetes and Digestive and Kidney Diseases (T35DK126628)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
Keywords
diabetic retinopathy, racial disparities, barriers to care, Hispanic patients, Black patients, childcare access, delayed care, patient-provider interaction, implicit bias, health equity, social determinants of health, access to eye care
MeSH terms
White, Adult, Aged, Black or African American, Cross-Sectional Studies, Diabetic Retinopathy, Female, Hispanic or Latino, Humans, Male, Middle Aged, United States, Cohort Studies, Health Care Surveys, Racial Groups, Healthcare Disparities, Social Determinants of Health

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