Social determinants of health associated with severe visual impairment

Social determinants of health (SDOH) are associated with severe visual impairment (SVI), according to a study published in JAMA Ophthalmology. Employment status, socioeconomic status, race and ethnicity, and health care coverage were associated with higher odds of SVI.

There are 32 million Americans who have reported blindness or impaired vision despite the use of glasses or contact lenses, making visual impairment one of the most common disabilities in the United States. SDOH has been found to be associated with the risk of visual impairment and its sequelae. The aim of this study was to use data from the Behavioral Risk Factor Surveillance System (BRFSS) to assess SDOH and their association with increased odds of self-reported SVI.

Data from January 2019 to December 2020 was obtained from the BRFSS web analytics tool. Independent variables were selected in the categories of demographic information, access to health care, healthy days, and chronic health conditions. Responses to survey questions constitute self-identifying data.

There were 820,226 participants in the BRFSS study; 53.07% were women and 5.17% self-identified as blind or severely visually impaired. Analysis of demographic factors included 633,866 participants.

The study found higher odds of SVI in American Indian/Alaska Native participants (odds ratio [OR]1.63; 95% CI, 1.38-1.91), Black/African American participants (OR, 1.50; 95% CI, 1.39-1.62), Hispanic participants (OR, 1.65; 95% CI, 1.53-1.79) and multiracial participants (OR, 1.33; 95% CI, 1.15-1.53) compared with a white, non-Hispanic reference group. No associations were found between SVI and gender or Asian and Pacific Islander participants.

Household income below $35,000 was associated with a greater risk of SVI and income of $50,000 and above with reduced odds of SVI. The group with the lowest annual household income, less than $10,000, was associated with higher odds of SVI (OR, 1.70; 95% CI, 1.52-1.90), whereas participants with an income of $75,000 or more had lower odds of SVI (OR, 0.59; 95% CI, 0.53-0.66).

Participants who did not complete high school had higher odds of SVI (OR, 1.50; 95% CI, 1.38-1.64), whereas participants who completed high school had lower odds ( OR, 0.73; 95% CI, 0.68-0.78) compared with a college-educated reference group.

Greater odds of SVI were found in participants who had been unemployed for 1 year or more (OR, 1.78; 95% CI, 1.54-2.07), were retired (OR, 2 .03; 95% CI, 1.89-2.19) or were unable to work (OR, 2.90; 95% CI, 2.66-3.16). Being divorced, widowed, or separated was also associated with higher odds of SVI (OR, 1.26; 95% CI, 1.18-1.34) compared with participants who were married.

A mental health diagnosis was associated with an overall greater odds of SVI (OR, 1.58; 95% CI, 1.48-1.69). Participants who reported having poor mental health on 14 or more days per month had increased odds of SVI (OR, 1.87; 95% CI, 1.73-2.02) compared with participants with no reported days of poor mental health.

Lack of health coverage was also associated with increased odds of SVI (OR, 1.22; 95% CI, 1.12-1.33), as was not being able to afford to see a doctor (OR, 1.62; 95% CI, 1.51-1.73). Not having a physician or more than 1 physician was not associated with SVI compared to participants who had 1 physician or health care professional.

There were some limitations to this study. The survey responses used were available in a compiled form rather than individually, which precluded more complex analysis. Additionally, the survey was conducted by telephone, which excluded potential participants without a landline or cell phone, individuals in correctional facilities, or individuals in long-term care homes. The participants in this study may also have had no access to eye care and the chances of low vision are increased due to this factor.

The researchers concluded that “ophthalmic health and vision are associated with SDOH, and visual impairment is associated with various disparities in care and barriers to accessing health care.”


Besagar S, Yonekawa Y, Sridhar J, et al. Association of socioeconomic, demographic, and health disparities in access to severe visual impairment. JAMA Ophthalmol. Published online November 3, 2022 doi:10.1001/jamaophthalmol.2022.4566

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