Low economic stability is linked with less eye care use in patients with diabetes

According to self-reported data from the National Health Interview Survey, greater socioeconomic burden correlates with lower utilization of eye care among patients with diabetes, especially when that burden involves economic instability.

Study design

This retrospective cross-sectional study evaluated the association of social determinants of health (SDoH) with eye care utilization among patients with diabetes using the 2013–2017 National Health Interview Survey (NHIS). Fifty-five survey questions evaluated 33 SDoH variables across 6 domains: (1) neighborhood, physical environment, and social cohesion; (2) economic stability; (3) food environment; (4) community and social context; (5) education; and (6) health care system. Aggregate scores were used to define SDoH quartiles—quartile 1 representing the lowest SDoH burden and quartile 4 representing the greatest burden—and these were used to group individuals and correlate burden with self-reported eye care utilization.


Of 20,807 adults with diabetes included in the study, 43% reported not having used eye care in the previous 12-month period. Participants in quartile 4 (higher socioeconomic burden) had 58% lower odds of using eye care than those in quartile 1. Adverse SDoH in all 6 domains were associated with a lack of eye care utilization, with economic instability showing the strongest association with decreased eye care use. These trends were consistent across race and ethnic groups as well as across patients with both type 1 and type 2 diabetes.


Due to the nature of the NHIS, this study relied on self-reported data, which can be inaccurate. Having a prescription for glasses was also used as an indicator of eye care use, even though filling a prescription for glasses does not necessarily mean a patient received a fundus exam for detecting retinopathy. In addition, patients were only asked about diabetic eye examinations in the previous year. This may not reflect the appropriate exam frequency for all patients, and for patients requiring more advanced care once-yearly exams may still represent undertreatment/underutilization of eye care resources.

Clinical significance

This study demonstrates the substantial impact of SDoH on eye care utilization. The findings point out SDoH barriers to care and underline the importance of addressing these adverse SDoH by connecting patients to needed socioeconomic services. Doing so can help underserved patients access eye care and has the potential to decrease the rate of vision loss, particularly in inner-city and rural communities.

Financial Disclosures: Dr. Lisa Schocket discloses no financial relationships.