PROJECT SUMMARY
This is an application for the NIH K23 Career Development Award. The goal of the proposed project is to
provide the candidate with advanced skills needed to become an independent clinician-scientist using data
science techniques to examine the role of social determinants of health in diabetic retinopathy. To facilitate this
long-term goal, the candidate proposes a comprehensive training plan including: 1) formal coursework and
obtaining a Master of Science in Applied Health Sciences Informatics, 2) practical hands-on training overseen
by her multidisciplinary mentoring team who span the fields of medicine, public health, and data science, and
3) involvement in seminars and workshops. Specific goals are to: 1) understand concepts in social
determinants of health and principles of public health interventions, 2) develop skills in data science research
including informatics and biostatistics, and 3) submit an NIH R01 and other non-NIH grants that build on the
findings of this project.
The research project will facilitate attainment of the career development goals. Lapses in care is a major
preventable cause of vision loss among patients with diabetic retinopathy (DR) and disproportionately affects
individuals of the lowest socioeconomic status. Social determinants of health (SDoH) play a critical role in
health outcomes and underlie these health disparities. Current attempts to systematically address SDoH in DR
have been limited by two missing components: accurate prediction of the at-risk population, and identification
of the most impactful SDoH. The focus of this research proposal is to address this gap. In Aim 1) we will use
an innovative approach of incorporating neighborhood-level SDoH measures, as obtained from the U.S.
Census Bureau measured on the block group level, to predict lapses in care. The hypothesis is that patients
from neighborhoods characterized by lower socioeconomic status, more housing and food insecurity, and
difficulty with healthcare access and affordability are more likely to experience lapses in DR care. In Aim 2) we
will construct a novel comprehensive SDoH framework that links socioeconomic status to lapses in DR care
through various intermediary SDoH including housing stability, food security, and healthcare (access,
affordability, and quality). We will use mediation analysis to identify the intermediary SDoH that most strongly
mediates the impact of socioeconomic status on lapses in DR care. The hypothesis is that access to
healthcare is a critical mediator. Results from this research will be used to develop a subsequent NIH R01
research proposal focused on designing targeted interventions to eliminate lapses in care and promote health
equity in DR.