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Racial disparities in diabetes care and outcomes for people with visual impairment: a descriptive analysis of the TriNetX research network
Journal article   Open access   Peer reviewed

Racial disparities in diabetes care and outcomes for people with visual impairment: a descriptive analysis of the TriNetX research network

Charisse Madlock-Brown, Austin Lee, Jaime Seltzer, Anthony Solomonides, Nisha Mathews, Jimmy Phuong, Nicole Weiskopf, William G Adams, Harold Lehmann and Juan Espinoza
BMC public health, Vol.25(1), 2508
07/19/2025
DOI: 10.1186/s12889-025-23606-2
PMCID: PMC12275416
PMID: 40684146
url
https://doi.org/10.1186/s12889-025-23606-2View
Published (Version of record) Open Access

Abstract

This research delves into the confluence of racial disparities and health inequities among individuals with disabilities, with a focus on those contending with both diabetes and visual impairment. Utilizing data from the TriNetX Research Network, which includes electronic medical records of roughly 115 million patients from 83 anonymous healthcare organizations, this study employs a directed acyclic graph (DAG) to pinpoint confounders and augment interpretation. We identified people with visual impairments using ICD-10 codes, deliberately excluding diabetes-related ophthalmology complications. Our approach involved multiple race-stratified analyses, comparing co-morbidities like chronic pulmonary disease in visually impaired patients against their counterparts. We assessed healthcare access disparities by examining the frequency of annual visits, instances of two or more A1c measurements, and glomerular filtration rate (GFR) measurements. Additionally, we evaluated diabetes outcomes by comparing the risk ratio of uncontrolled diabetes (A1c > 9.0) and chronic kidney disease in patients with and without visual impairments. The prevalence of diabetes was nearly doubled in individuals with visual impairments across White, Asian, and African American populations. Higher rates of chronic kidney disease were observed in visually impaired individuals, with a risk ratio of 1.731 for African Americans, 2.252 for White, and non-significant for the Asian group. A statistically significant difference in the risk ratio for uncontrolled diabetes was found only in the White cohort with one GFR reading (1.042). White individuals without visual impairments were less likely to receive an A1C test or a GFR test, while African American individuals with visual impairment were more likely to get both. Differences in testing were not significant for the Asian population. This study uncovers pronounced disparities in diabetes prevalence and management among individuals with visual impairments who seek care, particularly among White and African American groups. Our DAG analysis illuminates the intricate interplay between SDoH, healthcare access, and frequency of crucial diabetes monitoring practices, highlighting visual impairment as both a medical and social issue.
 Adult Aged Asian - statistics & numerical data Black or African American - statistics & numerical data Diabetes Mellitus - epidemiology Diabetes Mellitus - ethnology Diabetes Mellitus - therapy Female Healthcare Disparities - ethnology Healthcare Disparities - statistics & numerical data Humans Male Middle Aged Persons with Visual Disabilities - statistics & numerical data Renal Insufficiency, Chronic - epidemiology Renal Insufficiency, Chronic - ethnology Vision Disorders - ethnology White - statistics & numerical data

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