|Title||Associations Between Diabetes, Visual Difficulty, and Economic Well-Being: A Cross-Sectional Analysis of the Health and Retirement Study|
|Publication Type||Journal Article|
|Year of Publication||2023|
|Authors||Chung, G, Flood, D, Ehrlich, JR|
|Journal||Investigative Ophthalmology & Visual Science|
Purpose : Diabetic retinopathy is the leading non-refractive cause of vision loss in working-age U.S. adults. Prior studies have found that individuals with diabetes have lower levels of economic well-being. Therefore, we tested the hypothesis that adverse economic circumstances in working-age U.S. adults with diabetes are exacerbated among those with visual difficulty.
Methods : We used cross-sectional data from the 2016-17 Health and Retirement Study (HRS). Diabetes was defined as self-reported use of glucose-lowering medication or biochemical (glycosylated hemoglobin) evidence of diabetes. Visual difficulty was indicated by self-reported “fair” or “poor” distance vision. Outcome measures included annual income and household wealth. We used generalized linear models with gamma and log links to model these outcomes. Age, gender, race, marital status, education, and difficulty with any activities of daily living were included as covariates. All analyses were weighted with the HRS-provided respondent-level sample weights to make population-representative parameter estimates.
Results : Of 10,683 adults aged 40 to 64 with data on vision or diabetes status, 70.7% had no visual difficulty or diabetes, 10.5%, 14.8%, and 4.0% had visual difficulty alone, diabetes alone, and co-occurring visual difficulty and diabetes, respectively. When compared to adults without visual difficulty or diabetes, those with visual difficulty and diabetes had an average marginal decrease of income equal to -$20,827 (95% CI: -24,620, -17,035; p<0.001) and of household wealth equal to -$121,060 (95% CI: -173,738, -68,382; p<0.001). Adults with visual difficulty alone had an average marginal decrease of income equal to -$8,110 (95% CI: -11,543, -4,676; p<0.001) and of household wealth equal to -$63,738 (95% CI: -113,784, -13,691; p=0.013); adults with diabetes alone had an average marginal decrease of income equal to -$4,476 (95% CI: -6,877, -2,074; p<0.001) and of household wealth equal to -$89,315 (95% CI: -113,970, -64,661; p<0.001).
Conclusions : Working-age adults with co-occurring visual difficulty and diabetes have fewer financial resources and may be more prone to economic hardship than those with visual difficulty or diabetes alone. Public policies aimed at improving the economic well-being of individuals with multimorbidity should be prioritized.