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Associations Between Social Determinants of Health and Treatment of Exudative Age-Related Macular Degeneration: A Retrospective Cohort Analysis

Year: 2026

Type: article

Abstract: PURPOSE: To evaluate associations between social determinants of health (SDOH) and treatment rates among patients with exudative age-related macular degeneration (exAMD). METHODS: Research Program. The primary outcome was annual rate of intravitreal injections abstracted from the EHR. Negative binomial regression was used to assess associations between the treatment rate and individual SDOH constructs developed from survey responses among other sociodemographic factors, adjusting for bilateral disease status and follow-up duration. An exploratory factor analysis (EFA) of all SDOH constructs was performed to identify potential latent constructs associated with the primary outcome. RESULTS: Among sociodemographic factors, Black individuals had significantly lower injection rates (IRR: 0.32, 95% CI: 0.13-0.79) compared to White individuals. When correcting for multiple comparisons, among the SDOH constructs, there were none that were significantly associated with treatment rate. Within the exploratory factor analysis, a factor identified by poor English proficiency, transportation difficulty, rural care access issues, worse health literacy, and provider concordance issues was associated with a significantly decreased rate of treatment (IRR: 0.73, 95% CI: 0.55-0.96), as well as a factor identified by high neighborhood disorder, high loneliness, high perceived health care and everyday discrimination, and high stress (IRR: 0.74, 95% CI: 0.60-0.92). CONCLUSIONS: This study identifies significant racial disparities and SDOH constructs associated with exAMD treatment rates. These findings underscore the complexity of sociodemographic influences on treatment and suggest potential inequities which warrant additional study.

Source: Ophthalmic Epidemiology

DOI: 10.1080/09286586.2026.2645106

Authors: Timothy M. Janetos, Manjot K. Gill, Dustin D. French

Institution: Northwestern University

Language: English

Topic: Retinal Diseases and Treatments

Subfield: Ophthalmology

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: green

Funders: Research to Prevent Blindness, National Institutes of Health, National Center for Advancing Translational Sciences