Sociodemographic Factors Impact Visit Adherence in Patients with Wet AMD

Sociodemographic factors influence visit adherence among individuals with neovascular age-related macular degeneration (nAMD), according to a new analysis presented at the 2024 Association for Research in Vision and Ophthalmology (ARVO) Meeting.¹

Across a large healthcare system, patient factors, including type of insurance, social deprivation index, marital status, and race, were each linked with a significant impact on visit adherence for those with nAMD.

“These findings offer insight into how we can improve adherence and outcomes for patients with this debilitating eye disease,” said the investigative team, led by Alison Choi, department of ophthalmology, University of Pittsburgh School of Medicine.

Owing to their substantial efficacy in preserving and improving vision, the standard of care treatments for nAMD remains intravitreal anti-vascular endothelial growth factor (VEGF) injections.² Although there are understood barriers to vision care, particularly anti-VEGF injections, there are limits to its effect on nAMD patients in the United States.

A notable barrier is the need for frequent injections, requiring regular follow-up and impacting access to lower socioeconomic classes.³ Patients may struggle with the cost of treatment, lack of transportation, and living in a low-resource area, which contributes to disparities in adherence and access to eye care. Individuals who experience delays in care, or were lost to follow-up in nAMD treatment, are known to exhibit a significant decline in visual acuity down the line.²

Thus, social determinants of health may be a significant factor in the management of nAMD and create inequities in vision impairment in the US. In this study, Choi and colleagues conducted a retrospective, observational review to determine how socioeconomic barriers impact visit adherence in nAMD across a large healthcare system.¹

A total of 962 patients over the age of 18 years with nAMD in ≥1 eye, who were seen between 2018 and 2022, were included for analysis. Investigators obtained demographic and encounter data from the electronic medical records for the patient population.

The team measured the average number of days between visits and the distance from the home address to the preferred treatment center. Neighborhood socioeconomic disadvantage was determined and ranked using the Area Deprivation Index (ADI).

For the analysis, a Mann-Whitney U test evaluated the correlation between demographic variables and the mean number of days. Moreover, a Pearson correlation coefficient assess the relationship between ADI rank and distance, as well as the mean number of days between visits. Choi and colleagues set the significance at P ≤ .05.

Upon analysis, the team found that insurance type, social deprivation level, marital status, and race significantly impacted the mean number of days between clinic visits. Individuals with Medicaid or Medicare (70 days; n = 762) experienced a higher mean number of days (P = .007) than individuals with private insurance (63 days; n = 85) or those who paid out of pocket (64 days; n = 101).

Meanwhile, Choi and colleagues found the ADI rank was significantly, but weakly positively, associated with the mean number of days (r = .08; P = .012) and distance from home to the treatment center (r = .24; P = .00). By marriage status, those who were married (66 days; n = 460) had a lower number of days (P = .035) than non-married individuals (68 days; n = 469).

Although the participant numbers were low, demographic data showed both Black (105 days; n = 14) and Asian (92 days; n = 18) patients experienced a higher mean number of days between visits (P = .002) than White patients (67 days; n = 909).

“Several sociodemographic factors including insurance type, social deprivation, marital status, and race significantly impacted visit adherence for nAMD patients,” Choi and colleagues wrote.

References

1. _{Choi A, Nawash BS, Ong J, Sahel JA, Chhablani J. Evaluating the Influence of Sociodemographic Factors on Visit Adherence for Patients with Neovascular Age-Related Macular Degeneration. Poster presented at the Association for Research in Vision and Ophthalmology (ARVO) 2024 Meeting, May 5–9, 2024.}
2. _{Tan CS, Ngo WK, Chay IW, Ting DS, Sadda SR. Neovascular Age-Related Macular Degeneration (nAMD): A Review of Emerging Treatment Options. Clin Ophthalmol. 2022;16:917-933. Published 2022 Mar 25. doi:10.2147/OPTH.S231913}
3. _{Scanzera AC, Sherrod RM, Potharazu AV, et al. Barriers and Facilitators to Ophthalmology Visit Adherence in an Urban Hospital Setting. Transl Vis Sci Technol. 2023;12(10):11. doi:10.1167/tvst.12.10.11}