A-176 Social Determinants of Health and Diabetic Retinopathy in adults with Type 2 Diabetes Mellitus

Abstract

This study evaluated the association between social determinants of health (SDOH) and the presence of diabetic retinopathy (DR) among adults with type 2 diabetes mellitus (T2DM) receiving care at Temple University Health System campuses in Philadelphia. Following IRB approval, 932 patients were included in the analysis using data extracted from electronic health records between 2019 and 2024. DR status was determined via retinal imaging. SDOH were assessed at both the individual (interpreter use, insurance type, employment status) and community levels (Social Vulnerability Index [SVI]). Descriptive statistics were stratified by DR status. Multivariate logistic regression analyzed associations between SDOH, clinical factors, and DR, adjusting for confounders. Fourteen percent of participants had DR. Those with DR had higher rates of insulin use (36% vs 19%, p<0.001), higher systolic blood pressure (SBP) (138 vs 131 mmHg, more missed clinic appointments (4.57 vs 3.36, p=0.002), and higher HbA1c (latest HbA1c 7.74% vs 7.46%, p=0.04). In multivariate analyses, retired (aOR 1.64, 95% CI 0.66–4.06, p=0.28) and disability status (aOR 2.12, 95% CI 0.93–4.83, p=0.075) were associated with higher odds of DR but were not statistically significant after adjustment. Missed clinic appointments (aOR 1.12, 95% CI 1.03–1.22, p=0.007) and SBP (aOR 1.02, 95% CI 1.01–1.04, p=0.001) were significant independent predictors. Other SDOH were not significantly associated, and no interactions by sex, race, or ethnicity were observed. Among patients with T2DM, missed clinic visits and higher SBP were significant predictors of DR presence. Employment status showed trends toward increased risk but was not independently significant. Interventions targeting blood pressure control and consistent care management may reduce DR risk burden.