Association of the Robert Wood Johnson Foundations’ Social Determinants of Health and Medicare Ocular Hospitalizations: A Cross Sectional Data Analysis

Abstract

Introduction

Social determinants of health (SDH) may influence inpatient utilization rates and outcomes but have yet to be associated with ocular diagnoses. The purpose of this paper was to determine whether the SDH are associated with ocular hospitalizations.

Methods

Patients from the national Medicare 100% Inpatient Limited Dataset were examined and linked to SDH measures from the Robert Wood Johnson Foundation (RWJF) County Health Rankings. Patients were included in the study group with either an admitting or primary diagnosis of an ophthalmic condition. All other hospitalized Medicare patients served in the comparison group. Nested logistic regression of these Medicare patients was conducted in their respective communities at the county level. SDH measures were benchmarked above or below the national median.

Results

Positively associated SDH factors included communities with air pollution exceeding 11.62 micro grams per cubic meter (OR 1.05; 95% CI 1.01–1.08), communities where severe housing problems exceeding 14.38% (OR 1.13; 95% CI 1.09–1.18), children in single parent households exceeding 32.13% (OR 1.06; 95% CI 1.02–1.11), violent crime rate exceeding 250.54 per 100,000 (OR 1.07; 95% CI 1.03–1.12), diabetes exceeding 10.95% (OR 1.09: 95% CI 1.04–1.14), and drug poisoning deaths including opioids exceeding 14.17 per 100,000 (OR 1.04; 95% CI 1.01–1.08).

Conclusion

When compared to an all-condition, hospitalized population, ocular hospitalizations tended to have small, yet statistically significant associations with health behaviors, socioeconomic, and physical environment factors. Further research will be needed on how the physical environment, social, and community variables affect ocular health relative to all-cause hospitalizations.