Evaluating the Relationship between Neighborhood-Level Social Vulnerability and Patient Adherence to Ophthalmology Appointments

Objective Little is known about the association between neighborhood characteristics and non-adherence to attending scheduled ophthalmology appointments. The purpose of this study was to examine the association between neighborhood-level social vulnerability and adherence to scheduled ophthalmology appointments. Design Retrospective cohort study. Participants Adults aged 18 years and older with scheduled ophthalmology appointments between September 12, 2020, and February 8, 2021. Methods A single-center study was conducted at the University of Illinois Chicago Illinois Eye and Ear Infirmary, an urban tertiary care referral center in Chicago, Illinois. Primary exposure is neighborhood-level Social Vulnerability Index (SVI), based on the patient’s address of residence. The SVI ranks (possible range 0 to 1) each census tract on 15 social factors into four related themes (socioeconomic status, household composition & disability, minority status & language, and housing type & transportation). Higher SVI rankings indicate higher levels of social vulnerability. The overall SVI ranking and rankings for each of the four themes were analyzed separately as the primary exposure of interest in multivariable logistic regression models that controlled for age, sex, status (new or established appointment), race, and distance from clinic. Main Outcome Measure Non-adherence to attending scheduled ophthalmology appointments, defined as missing more than 25% of scheduled appointments. Results A total of 8,322 unique patients (41% non-Hispanic Black, 24% Hispanic, 22% non-Hispanic White) had scheduled appointments during the five-month study period (range 1 to 23 appointments). Of those, 28% of patients were non-adherent to appointments. In multivariable logistic regression models, non-adherence to appointments was associated with living in higher SVI ranking neighborhoods (socioeconomic status: (adjusted odds ratio [95% confidence interval]) 2.38 [1.94, 2.91]; household composition/disability: 1.51 [1.26, 1.81]; minority status/language: 2.03 [1.55, 2.68]; housing type/transportation: 1.41 [1.16, 1.73]; and overall SVI: 2.46 [1.99, 3.06]). Conclusions Neighborhood-level measures of social vulnerability are associated with greater risk of non-adherence to scheduled ophthalmology appointments. Studies to better understand these neighborhood-level vulnerabilities are needed to inform the design and evaluation of multi-level (individual and neighborhood) strategies to reduce disparities in access to ophthalmology care.