Impact of Social Determinants of Health in Diabetic Retinopathy

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PROJECT SUMMARY This is an application for the NIH K23 Career Development Award. The goal of the proposed project is to provide the candidate with advanced skills needed to become an independent clinician-scientist using data science techniques to examine the role of social determinants of health in diabetic retinopathy. To facilitate this long-term goal, the candidate proposes a comprehensive training plan including: 1) formal coursework and obtaining a Master of Science in Applied Health Sciences Informatics, 2) practical hands-on training overseen by her multidisciplinary mentoring team who span the fields of medicine, public health, and data science, and 3) involvement in seminars and workshops. Specific goals are to: 1) understand concepts in social determinants of health and principles of public health interventions, 2) develop skills in data science research including informatics and biostatistics, and 3) submit an NIH R01 and other non-NIH grants that build on the findings of this project. The research project will facilitate attainment of the career development goals. Lapses in care is a major preventable cause of vision loss among patients with diabetic retinopathy (DR) and disproportionately affects individuals of the lowest socioeconomic status. Social determinants of health (SDoH) play a critical role in health outcomes and underlie these health disparities. Current attempts to systematically address SDoH in DR have been limited by two missing components: accurate prediction of the at-risk population, and identification of the most impactful SDoH. The focus of this research proposal is to address this gap. In Aim 1) we will use an innovative approach of incorporating neighborhood-level SDoH measures, as obtained from the U.S. Census Bureau measured on the block group level, to predict lapses in care. The hypothesis is that patients from neighborhoods characterized by lower socioeconomic status, more housing and food insecurity, and difficulty with healthcare access and affordability are more likely to experience lapses in DR care. In Aim 2) we will construct a novel comprehensive SDoH framework that links socioeconomic status to lapses in DR care through various intermediary SDoH including housing stability, food security, and healthcare (access, affordability, and quality). We will use mediation analysis to identify the intermediary SDoH that most strongly mediates the impact of socioeconomic status on lapses in DR care. The hypothesis is that access to healthcare is a critical mediator. Results from this research will be used to develop a subsequent NIH R01 research proposal focused on designing targeted interventions to eliminate lapses in care and promote health equity in DR.