Impact of Socioeconomic Disadvantage on Clinical Outcomes of Inflammatory Eye Disease Patients Requiring Systemic Immunosuppression

Purpose Assess the impact of socioeconomic disadvantage on time to ocular inflammation control in patients treated with systemic immunosuppression.Methods We performed a retrospective, observational study of 199 patients followed at the University of Wisconsin-Madison uveitis clinic for inflammatory ocular diseases treated with systemic immunomodulatory therapy. We conducted a time-to-event analysis using a Cox proportional hazards regression model to evaluate the impact of socioeconomic status, as characterized by the Area Deprivation Index (ADI), a neighborhood level ranking of socioeconomic disadvantage, on control of ocular inflammation. The main outcome measure was the earliest follow-up with control of ocular inflammation within 12 months.Results Increased ADI, representing greater socioeconomic disadvantage, was associated with a decreased likelihood of ocular inflammation control following treatment with systemic immunosuppressants within 12 months of follow up (10.4% decrease for a 10 unit increase in ADI, HR = 1.12, 95% CI: [1.00, 1.25], p = 0.05) after conditioning for patient age, insurance, and immunosuppressive class. ADI positively correlated with travel distance from the clinic (p < 0.001), but travel distance in minutes lacked evidence for an effect on inflammation control.Conclusions Time to control of ocular inflammatory disease with systemic immunosuppression is adversely impacted by greater socioeconomic disadvantage as measured by ADI.