Social Factors Associated With Progression From Nonproliferative to Proliferative Diabetic Retinopathy

Document Type

Conference Proceeding

Publication Date

6-2026

Publication Title

Investigative Ophthalmology and Visual Science

Abstract

Purpose : The progression of nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) may involve a complex interplay of various clinical risk factors along with social determinants of health (SDoH). This study is focused on evaluating how SDoH are associated with the progression from NPDR to PDR.

Methods : We obtained a cohort of patients diagnosed with diabetic retinopathy from the NIH All of US Research Program database. From there, we analyzed their responses to 10 dichotomous (yes/no) questions in the Healthcare Access and Utilization Survey pertaining to affordability of medical care and medications. Pearson Chi-square tests generated unadjusted P values, with the Holm-Bonferroni adjustment applied for multiple comparisons between characteristics and survey responses. We performed Cox proportional hazards regression models to obtain hazard ratios (HR) and 95% confidence intervals (CI) for the association between social factors and progression to PDR. Values of p< 0.05 were statistically significant.

Results : Our cohort consisted of 2,348 patients with NPDR. Over the study period, 300 (12.8%) individuals converted to PDR, with a mean time to event of 2,615 days. The mean age was 70 years old (IQR: 62-77) and 68 years old (IQR: 60-75) for the non-conversion and conversion group, respectively. Those who converted to PDR were significantly more likely to be older (p=0.012), unmarried (p=0.002), or non-Hispanic African American or Hispanic (any race) (p=0.018). Factors associated with the highest risk of conversion to PDR included not being able to afford medication (HR: 1.40; 95% CI: 1.18-1.68) and delaying filling medication (HR: 1.27; 95% CI: 1.04-1.58) (Figure 1) as well as barriers to care regarding inability to afford follow-up care (HR: 1.30; 95% CI: 1.01-1.68), and not having transportation (HR: 1.32; 95% CI: 1.10-1.60) (Figure 2).

Conclusions : We observed that a lack of access to care conferred a significant risk of progression to PDR. Clinicians should take a proactive role in understanding the patient’s unique socioeconomic factors and tailor treatments with accessibility and affordability in mind.

Volume

67

Issue

7

First Page

3708

Comments

Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, May 3-7, 2026, Denver, CO

Last Page

3708

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