Association Between Social Determinants of Health and Examination-Based Vision Loss vs Self-reported Vision Measures

IMPORTANCE: Recent evidence suggests that social determinants of health (SDOH) affect vision loss, but it is unclear whether estimated associations differ between clinically evaluated and self-reported vision loss. OBJECTIVE: To identify associations between SDOH and evaluated vision impairment and to assess whether these associations hold when examining self-reported vision loss. DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional comparison included participants 12 years and older in the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES), participants of all ages (infants and older) in the 2019 American Community Survey (ACS), and adults 18 years and older in the 2019 Behavioral Risk Factor Surveillance System (BRFSS). EXPOSURES: Five domains of SDOH that are based on Healthy People 2030: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. MAIN OUTCOMES AND MEASURES: Presenting vision impairment of 20/40 or worse in the better-seeing eye (NHANES) and self-reported blindness or serious difficulty seeing, even with glasses (ACS and BRFSS). RESULTS: Of 3 649 085 included participants, 1 873 893 were female (51.1%) and 2 504 206 were White (64.4%). SDOH across domains of economic stability, educational attainment, health care access and quality, neighborhood and built environment, and social context were significant predictors of poor vision. For example, higher income (poverty to income ratio [NHANES]: OR, 0.91; 95% CI, 0.85-0.98; [ACS]: OR, 0.93; 95% CI, 0.93-0.94; categorical income [BRFSS: