Risk Factors for Diabetic Retinopathy Among Homeless Veterans

Homeless patients have high rates of visual impairment and lower rates of glycemic control than housed patients. Although diabetic retinopathy (DR) is the most common cause of new visual impairment and legal blindness in the developed world, little is known about differential risk factors for and ra...

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Bibliographic Details
Published in:Psychological services 2017-05, Vol.14 (2), p.221-228
Main Authors: Davis, John A., Tsui, Irena, Gelberg, Lillian, Gabrielian, Sonya, Lee, Martin L., Chang, Evelyn T.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anemia
Blindness
Blood pressure
Demography
Diabetes
Diabetic retinopathy
Diabetic Retinopathy - diagnosis
Female
Glycemic control
Homeless
Homeless people
Homeless Persons
Housing
Human
Humans
Insulin
Male
Medical screening
Medicine
Mental disorders
Mental health
Mental health care
Mental health services
Middle Aged
Military Veterans
Patients
Physical disabilities
Primary care
Psychosocial factors
Retinopathy
Risk Factors
Substance abuse
Substance use disorder
Tests
Veterans
Vision Disorders
Visual impairment
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Summary:Homeless patients have high rates of visual impairment and lower rates of glycemic control than housed patients. Although diabetic retinopathy (DR) is the most common cause of new visual impairment and legal blindness in the developed world, little is known about differential risk factors for and rates of DR in homeless versus housed populations. This study aimed to compare the rates of DR between homeless and housed patients with diabetes at the Greater Los Angeles Veterans Affairs Health care System (GLA) and identify clinical and psychosocial predictors of DR rates. We performed secondary database analyses of veterans with diabetes who received care at GLA between October 1, 2013 and September 30, 2015. We described differences in demographic, clinical, and psychosocial characteristics associated with DR in homeless versus housed patients, and created a logistic regression model to identify independent predictors of DR. We found that diabetic veterans who were homeless, as compared with those who were housed, had higher rates of substance use disorders and mental health diagnoses, more primary care and mental health visits, and were more likely to have had diabetic retinopathy eye screening according to guidelines. Multiple logistic regression modeling predicting having DR, revealed that having DR was independently associated with not being homeless (i.e., being housed), older age, having had retinal screening, anemia, higher systolic blood pressure, insulin use, microalbuminuria, and higher HbA1c. Homeless diabetic veterans' lower rates of DR may be due to the GLA VA's tailored and intensive psychological and medical resources for homeless veteran patients.
ISSN:1541-1559
1939-148X
DOI:10.1037/ser0000148