The sight of disparity: how social determinants shape visual impairment and blindness across the U.S.

Visual impairment and blindness are a growing public health challenge in the United States, creating burdens on individuals and on society as a whole. Social and geographic factors are known to have substantial impacts on eye health. Our study examined this issue by analyzing differences between social determinants of health (SDH) in the southern and northern United States and correlating these differences with vision loss. We hypothesized that SDH, including race and ethnicity, age, socioeconomic status, access to healthcare, and geographic location, correlate with visual impairment and blindness rates. To test this, we used publicly available data from 18 states (9 northern, 9 southern) to examine associations among these SDH and vision loss. A Bayesian correlation analysis revealed very strong association of vision loss with poverty (r = 0.918) and education (r = -0.735) and moderate association with optometrist density (r = -0.610) and a higher Black population (r = 0.566). Southern states showed higher rates of vision loss than northern states and had lower optometrist densities, higher poverty, lower education, and a larger Black population. These findings reveal that SDH significantly influence vision health, reflecting broader disparities in healthcare access and socioeconomic status. Policymakers and community leaders must address these systemic issues to reduce inequity in vision health. Targeted public health interventions are needed in underserved populations, particularly those in the southern United States. By identifying the SDH that correlate with visual impairment and blindness, our study provides a framework for addressing disparities in eye health across the U.S.