Skip to main content

  • Social Determinants of Health and Visual Impairment

    By Jean Shaw
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
    Add to My Bookmarks

    Journal Highlights

    JAMA Ophthalmology, December 2022

    Download PDF

    Which social determinants of health (SDOH) are associated with severe visual impairment (VI) in the United States? Besagar et al. investigated this question and found multiple social disparities and barriers to health care access.

    For this quality improvement study, the researchers used cross-section­al data for 2019 and 2020 from the Behavioral Risk Factor Surveillance System (BRFSS), an annual telephone survey conducted by the CDC. The main outcome was severe VI associat­ed with factors such as race/ethnicity, household income, education level, and employment status.

    From January 2019 to December 2020, 820,226 people (53.07% female) participated in the BRFSS survey. Of these, 42,412 (5.17%) self-identified as being blind or having “serious difficul­ty” seeing, even while wearing glasses.

    For the demographic factors anal­ysis, the researchers evaluated 77.3% of the total surveyed participants (n = 633,866). The results were as follows:

    • Race/ethnicity. Compared with Whites, non-Hispanic individuals, who served as the reference value (OR, 1), the risk of severe VI was highest for Hispanic, Native American, Black, and multiracial individuals (ORs, 1.65, 1.63, 1.50, and 1.33, respectively).
    • Income. Household income less than $35,000 per year was associated with greater odds of severe VI, while income of $50,000 or more was associ­ated with decreased odds. Those with the lowest annual income (<$10,000) had an OR of 1.70, while those with the highest income (>$75,000) had an OR of .59.
    • Education. Those who did not com­plete high school had an OR of 1.50, versus .73 for those who completed college or a technical school.
    • Employment status. Those who reported not working for a year or more, being retired, or being unable to work also had greater odds of severe VI; the ORs for these participants were 1.78, 2.03, and 2.90, respectively.
    • Access to care. For the analysis of health care access factors, the research­ers evaluated 90% of the total surveyed participants (n = 734,614). The results of this analysis indicated that lack of health care coverage was associated with a greater likelihood of severe VI (OR, 1.22). Those who had needed care in the last 12 months but who could not afford it also had greater odds of severe VI (OR, 1.62). (Also see related commentary by Patrice M. Hicks, PhD, MPH; Maria A. Woodward, MD, MS; and Paula Anne Newman-Casey, MD, MS, in the same issue.)

    The original article can be found here.