To assess whether increased poverty is associated with increased risk of screening positive for glaucoma or suspected glaucoma in a large public screening and intervention program.
Cross-sectional study from 2020-22.
Adults ≥18 years old without acute ocular symptoms.
Michigan Screening and Intervention for Glaucoma and eye Health through Telemedicine (MI-SIGHT) Program participants’ socio-demographic characteristics and area deprivation index (ADI) values were summarized from the clinical sites, which included a free clinic and a Federally Qualified Health Center (FQHC). ADI, a composite measure of neighborhood deprivation [range 1-10;10 is worst deprivation] was assigned based on participants’ addresses. Group comparisons were performed via two-sample t-tests or Wilcoxon-Mann-Whitney tests for continuous measures and Chi-square tests or Fisher exact tests with Monte Carlo simulation for categorical measures; Holm adjustment was used for multiple comparisons.
Risk factors for screening positive for glaucoma/suspected glaucoma.
Of the 1,171 enrolled participants, 1,165 (99.5%) completed the screening; 34% at the free clinic and 66% at the FQHC. Participants were on average 55.1±14.5 years old, 62% women, 54% self-reported being Black/African-American, 34% White, and 10% Latino/a/x, 70% earned less than $30,000 annually. The mean ADI was 7.2±3.1. The FQHC had higher (worse) ADI than the free clinic (free clinic: 4.5±2.9, FQHC: 8.5±2.1, p<0.0001). A quarter (24%) of participants screened positive for glaucoma/suspected glaucoma. Screening positive for glaucoma/suspected glaucoma was associated with being older (p=0.01), identifying as Black/African-American (p=0.0001), having an established eyecare clinician (p=0.0005), and not driving a personal vehicle to the appointment (p=0.001), which is a proxy for increased poverty. Participants who screened positive had worse ADI compared to those who screened negative (7.7±2.8 vs 7.0±3.2, p=0.002). A larger percentage of White participants screened positive at the FQHC compared to White participants at the free clinic (21.3% vs 12.3%, p=0.01). FQHC White participants had worse ADI than free clinic White participants (7.5±2.5 vs 3.7±2.7, p<0.0001).
Personal poverty, assessed as not driving a personal vehicle to the appointment, and neighborhood level poverty were both associated with increased rates of screening positive for glaucoma/suspected glaucoma.
Copyright © 2023. Published by Elsevier Inc.
