Elevated Prevalence of Age‐Related Macular Degeneration in a Low‐Income Urban Primary Care Setting
Open accessAbstract
Abstract Background Age-related macular degeneration (AMD) is the leading cause of vision loss among adults over 50. Early detection enables interventions such as Age-Related Eye Disease Study (AREDS) supplementation to slow disease progression, yet AMD remains underdiagnosed in primary care, particularly in underserved populations. This study assessed AMD sample prevalence and its association with social determinants of health in a diverse, urban primary care cohort. Methods We performed a post hoc analysis of a cross-sectional study conducted from June 2020 to May 2023 at a hospital-based primary care clinic in New York City (NYC). Patients aged 50–89 underwent nonmydriatic color fundus photography graded independently by two physicians using Beckman Initiative criteria. Median household income by ZIP code served as a proxy for socioeconomic position. Multivariable logistic regression examined associations between AMD and demographic or social determinants of health variables. Results Of 393 patients enrolled, 312 were included in the final analysis. Referable AMD was present in 48.4% of participants based on the Beckman classification, representing the sample prevalence within this clinic cohort and exceeding national population-based estimates. Only 4 of 151 AMD cases had been previously diagnosed. Referable AMD prevalence was higher in males than females (56.2% vs. 44.4%) and increased with age. Median household income was significantly lower among patients with referable AMD compared with those without ($72,000 vs. $151,000; p < 0.0001). In adjusted models, male sex (OR = 2.00, 95% CI 1.02–4.00) and lower income were strongly associated with referable AMD prevalence; race and age were not. Conclusion Undiagnosed referable AMD was highly prevalent within this primary care clinic sample of low-income, urban patients. Integrating affordable retinal screening, potentially aided by artificial intelligence, into primary care may help address vision health disparities driven by social determinants of health.
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Studies in low-income primary care settings confirm that household income and neighborhood position each independently relate to disease burden.
“Studies in low‐income primary care settings confirm that household income and neighborhood position each independently relate to disease burden [17].”
From Artificial Intelligence and Machine Learning for Identifying Social Determinants of Health in Low‐Income Populations Within United States Health Systems: A Scoping Review (2026) · cites this paper as [17]
The Results report that lower income was independently associated with higher prevalence of referable AMD in an urban primary care cohort. However, the Strengths and limitations section says income was approximated using ZIP code–linked census data; the study did not establish separate, independent associations for household income and neighborhood position. Its finding also concerns AMD, not disease burden generally. (LLM, conf=0.88)
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Cites
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Clinical Classification of Age-related Macular Degeneration
Ferris, F. L., Wilkinson, C. P., Bird, A. C., Chakravarthy, U., Chew, E. Y., Csaky, K. G., & Sadda, S. R. (2013) · Ophthalmology · doi:10.1016/j.ophtha.2012.10.036 · Cited by 1,868 · see citing works
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Self-citationPrevalence of Undiagnosed Age-Related Macular Degeneration in Primary Eye Care
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Research works printed but not linked: 2
- [9]Gloriane Schnabolk. Systemic Inflammatory Disease and AMD Comorbidity. Adv Exp Med Biol. 2019;1185:27–31. 10.1007/978-3-03027378-1_5. 31884584 · DOI
- [10]National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division, Board on Population Health and Public Health Practice; Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health.; Welp A, Woodbury RB, McCoy MA, eds. Making eye health a population health imperative: vision for tomorrow. Washington, DC: National Academies Press (US). Chapter 2, Understanding the Epidemiology of Vision Loss and Impairment in the United States. 2016. https://www.ncbi.nlm.nih.gov/books/NBK402366/. Accessed 25 Aug 2024.
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Razzano, A. V. (2026) · Health Science Reports · doi:10.1002/hsr2.73083
- Authors
- Kaganovski, A., Bhuiyan, A., Kasi, A., Kamyab, D., Grinberg, A., Chen, S., Thomson, R., Bhuiyan, T., Govindaiah, A., Deobhakta, A., Lema, G., Tai, K., Weissman, M. A., Amoruso, L., & Smith, R. T.
- Affiliations
- Mount Sinai Health System (US)
- SUNY Downstate Health Sciences University (US)
- The College of New Jersey (US)
- The University of Texas Health Science Center at Houston (US)
- Maimonides Medical Center (US)
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Kaganovski, Adriana
- ORCID
- Venue
- Discover Public Health
- Published
- 2026-03-14
- Volume
- 23
- Issue
- 1
- Pages
- 321-321
- ISSN
- 3005-0774 (ISSN-L)
- PMC
- PMC12989009
- OpenAlex
- W7135402366
- Cited by
- 1
- References
- 10
- Citations by year
- 2026: 1
- FWCI
- 7.82
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Discover Public Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute of Health SBIR (USA project grant #1R44EY031202-01A1)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Medicine › Epidemiology › Ophthalmology and Visual Impairment Studies
- Keywords
- age-related macular degeneration, prevalence, underdiagnosis, social determinants of health, socioeconomic status, household income, low-income populations, urban primary care, retinal screening, color fundus photography, sex differences, older adults
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