Social determinants of health impacting adherence to diabetic retinopathy examinations.
Social determinants of health impacting adherence to diabetic retinopathy examinations.
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DOI：
10.1136/bmjdrc-2021-002374
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发表时间：
2021-09
影响因子：
4.1
通讯作者：
McCarthy ML
中科院分区：
文献类型：
--
作者：
Cai CX;Li Y;Zeger SL;McCarthy ML
这项研究评估了多维社会健康决定因素(SDoH)与不遵守糖尿病视网膜病变检查的关系。这是一项对华盛顿特区医疗补助计划注册者进行的前瞻性队列研究中对成年糖尿病患者的特别小组分析。在研究登记时，参与者接受了基于世卫组织SDoH模型的全面SDoH调查。坚持推荐的扩张型糖尿病视网膜病变检查，由保险索赔中合格的当前程序术语代码确定，定义为在研究登记后的两年内至少进行一次眼睛检查。在这项前瞻性研究中登记的8,943名参与者中，1,492名(女性，91%非西班牙裔黑人)被纳入这项特别分组分析。47.7%(n=712)的患者坚持推荐的两年一次的糖尿病眼科检查。在控制了年龄、性别、种族/民族、使用慢性残疾支付系统的总体健康状况、使用糖尿病并发症严重程度指数的糖尿病严重程度、糖尿病眼病治疗史的多因素Logistic回归分析中，没有固定提供者(例如，初级保健医生)和居住条件差(例如，过度拥挤、供暖不足)与接受糖尿病眼科检查的几率降低(分别为0.45(95%CI 0.31至0.64)和0.70(95%CI 0.53至0.94))相关。对SDoH的多维评估揭示了影响对糖尿病视网膜病变检查依从性的障碍。住房条件差和没有固定的提供者与遵从性差有关。可以将简短的SDoH评估纳入常规临床护理，以识别社会风险，并将患者与必要的资源联系起来，以提高对糖尿病视网膜病变检查的依从性。
This study evaluates the association of multidimensional social determinants of health (SDoH) with non-adherence to diabetic retinopathy examinations. This was a post-hoc subgroup analysis of adults with diabetes in a prospective cohort study of enrollees in the Washington, DC Medicaid program. At study enrollment, participants were given a comprehensive SDoH survey based on the WHO SDoH model. Adherence to recommended dilated diabetic retinopathy examinations, as determined by qualifying Current Procedural Terminology codes in the insurance claims, was defined as having at least one eye examination in the 2-year period following study enrollment. Of the 8943 participants enrolled in the prospective study, 1492 (64% female, 91% non-Hispanic Black) were included in this post-hoc subgroup analysis. 47.7% (n=712) were adherent to the recommended biennial diabetic eye examinations. Not having a regular provider (eg, a primary care physician) and having poor housing conditions (eg, overcrowded, inadequate heating) were associated with decreased odds of adherence to diabetic eye examinations (0.45 (95% CI 0.31 to 0.64) and 0.70 (95% CI 0.53 to 0.94), respectively) in the multivariate logistic regression analysis controlling for age, sex, race/ethnicity, overall health status using the Chronic Disability Payment System, diabetes severity using the Diabetes Complications Severity Index, history of eye disease, and history of diabetic eye disease treatment. A multidimensional evaluation of SDoH revealed barriers that impact adherence to diabetic retinopathy examinations. Having poor housing conditions and not having a regular provider were associated with poor adherence. A brief SDoH assessment could be incorporated into routine clinical care to identify social risks and connect patients with the necessary resources to improve adherence to diabetic retinopathy examinations.
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影响因子：
16.2
作者：
Kirkman, MS;Williams, SR;Marrero, DG
通讯作者：
Marrero, DG
影响因子：
13.7
作者：
Olsen, Timothy W.;Al-Rajhi, Ali;Lum, Flora C.
通讯作者：
Lum, Flora C.
影响因子：
8.1
作者：
Keenum, Zachary;McGwin, Gerald, Jr.;Owsley, Cynthia
通讯作者：
Owsley, Cynthia
影响因子：
1.8
作者：
An, JaeJin;Niu, Fang;Cheetham, T. Craig
通讯作者：
Cheetham, T. Craig
影响因子：
8.1
作者：
Gibson, Diane M.
通讯作者：
Gibson, Diane M.