Associations of Social Determinants of Health and Self-Reported Visual Difficulty: Analysis of the 2016 National Health Interview Survey

Purpose: To determine the association of selected social determinants of health (SDH) assessed by the National Health Interview Survey (NHIS) among adults with visual difficulty. Methods: Data from adults 18 years of age and older relevant to self-reported visual difficulty were extracted from the 2016 NHIS dataset. A multivariate logistic regression model was used to determine associations between self-reported visual difficulty and key social determinants of health identified by the Kaiser Family Foundation and American College of Physicians. Outcomes were reported as odds ratios (OR) with 95% confidence intervals (CI). Results: Self-reported visual difficulty was significantly associated with lower educational attainment (OR 1.54; 95% CI, 1.30-1.81), having healthcare coverage through Medicaid (OR 1.44; 95% CI, 1.23-1.67), food insecurity (OR 1.75; 95% CI, 1.54-1.99), problems with paying medical bills (OR 1.60; 95% CI, 1.40-1.83), trouble finding a doctor (OR 1.49; 95% CI, 1.19-1.86), cost-related medication underuse (OR 1.72; 95% CI, 1.54-1.93), and identification as a non-heterosexual male (OR 1.82; 95% CI, 1.21-2.73). Those who were employed were at lower risk of visual difficulty compared to those who were looking for work or not working (OR 0.79; 95% CI, 0.71-0.89). Conclusion: A subset of SDH as evaluated by the NHIS are positively associated with self-reported visual difficulty. If validated, these results could inform future public health interventions that may reduce the incidence and burden of visual difficulty.