Place-Based Measures of Inequity and Vision Difficulty and Blindness

Patrice M Hicks; George Lin; Paula Anne Newman-Casey; Leslie M Niziol; Ming-Chen Lu; Maria A Woodward; Angela R Elam; David C Musch; Roshanak Mehdipanah; Joshua R Ehrlich; David B Rein

doi:10.1001/jamaophthalmol.2024.1207

Place-Based Measures of Inequity and Vision Difficulty and Blindness

JAMA Ophthalmol. 2024 May 9:e241207. doi: 10.1001/jamaophthalmol.2024.1207. Online ahead of print.

Authors

Patrice M Hicks^{1

2}, George Lin¹, Paula Anne Newman-Casey^{1

3}, Leslie M Niziol¹, Ming-Chen Lu¹, Maria A Woodward^{1

3}, Angela R Elam^{1

3}, David C Musch^{1

4}, Roshanak Mehdipanah^{2

5}, Joshua R Ehrlich^{1

3

6}, David B Rein⁷

Affiliations

¹ Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor.
² Housing Solutions for Health Equity, University of Michigan, Ann Arbor.
³ Institute for Health Policy and Innovation, University of Michigan, Ann Arbor.
⁴ Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor.
⁵ Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor.
⁶ Institute for Social Research, University of Michigan, Ann Arbor.
⁷ NORC, University of Chicago, Chicago, Illinois.

PMID: 38722650
PMCID: PMC11082749 (available on 2025-05-09)
DOI: 10.1001/jamaophthalmol.2024.1207

Abstract

Importance: Known social risk factors associated with poor visual and systemic health in the US include segregation, income inequality, and persistent poverty.

Objective: To investigate the association of vision difficulty, including blindness, in neighborhoods with measures of inequity (Theil H index, Gini index, and persistent poverty).

Design, setting, and participants: This cross-sectional study used data from the 2012-2016 American Community Survey and 2010 US census tracts as well as Theil H index, Gini index, and persistent poverty measures from PolicyMap. Data analysis was completed in July 2023.

Main outcomes and measures: The main outcome was the number of census tract residents reporting vision difficulty and blindness (VDB) and the association with the Theil H index, Gini index, or persistent poverty, assessed using logistic regression.

Results: In total, 73 198 census tracts were analyzed. For every 0.1-unit increase in Theil H index and Gini index, there was an increased odds of VDB after controlling for census tract-level median age, the percentage of the population that identified as female sex, the percentage of the population that identified as a member of a racial or ethnic minority group, state, and population size (Theil H index: odds ratio [OR], 1.14 [95% CI, 1.14-1.14; P < .001]; Gini index: OR, 1.15 [95% CI, 1.15-1.15; P < .001]). Persistent poverty was associated with an increased odds of VDB after controlling for census tract-level median age, the percentage of the population that identified as female sex, the percentage of the population that identified as a member of a racial or ethnic minority group, state, and population size compared with nonpersistent poverty (OR, 1.36; 95% CI, 1.35-1.36; P < .001).

Conclusions and relevance: In this cross-sectional study, residential measures of inequity through segregation, income inequality, or persistent poverty were associated with a greater number of residents living with VDB. It is essential to understand and address how neighborhood characteristics can impact rates of VDB.