Disparities in social determinants of health and healthcare barriers among patients with cataracts

To evaluate how social determinants of health (SDoH) and self-reported barriers to healthcare access vary by income, age, sex, race, and insurance status among adults with cataracts in the NIH All of Us Research Program. Cross-sectional observational study. Adults aged ≥18 years with a diagnosis of cataract who completed both the SDoH and Healthcare Access and Utilization surveys in the All of Us database (N = 22,751). Survey responses assessing perceived neighborhood safety, food insecurity, discrimination in healthcare, and delays in care over the prior 12 months were analyzed. Multivariable logistic regression models were constructed for each outcome, adjusting for age, sex, race/ethnicity, income, and insurance status. Self-reported neighborhood safety, food insecurity, perceived discrimination in healthcare settings, and financial or logistical delays in obtaining medical care. After adjustment, Black participants had higher odds of reporting neighborhood crime (OR 2.96, 95%CI 2.50-3.50), food insecurity (OR 1.78, 95%CI 1.49-2.13), and discrimination in healthcare compared with White participants. Similar patterns were observed among Hispanic participants. Lower income was strongly associated with reported financial barriers, with participants earning <$35,000 demonstrating higher odds of delaying care due to copays (OR 8.06, 95%CI 6.80-9.56). Younger age and female sex were associated with higher odds of reporting logistical barriers. Insurance status was not independently associated with reported delays after adjustment. Among adults with cataracts, disparities in SDoH and healthcare access were strongly associated with socioeconomic factors, particularly income. These findings suggest that financial constraints may play a greater role than insurance status alone in influencing access to care. Addressing structural and socioeconomic barriers may be important for reducing disparities in healthcare access within this population.