Association of Race, Ethnicity, and Socioeconomic Status With Visual Impairment in Adolescent Children in the US

Abstract

ImportanceAlthough racial, ethnic, and socioeconomic disparities in visual impairment have been described in adults, few studies have focused on the adolescent population, which may provide insight into the emergence of vision health inequities.ObjectiveTo describe visual health disparities among adolescent children in the US.Design, Setting, and ParticipantsThis was a cross-sectional study of adolescents from the 2005 to 2008 National Health and Nutrition Examination Survey. Participants were aged 12 to 18 years with a completed visual function questionnaire and eye examination. Data analyses were conducted from January 19 to July 20, 2022.Main Outcomes and MeasuresOutcomes included subjective (self-reported poor vision) and objective (visual acuity worse than 20/40 in the better-seeing eye) measures of visual function. Multivariable logistic and linear regression analyses were conducted to examine the association between the sociodemographic risk factors and each outcome, adjusting for age, sex, and other covariates.ResultsThe 2833 included participants (mean [SD] age, 15.5 [2.0] years; 1407 female participants [49%]) represent a survey-weighted 57 million US adolescent children, of whom 14% were non-Hispanic Black participants (876), 11% were Mexican American participants (828), 63% were non-Hispanic White participants (816), and 11% were other race and ethnicity (313). A total of 5% of participants (266) were not US citizens, and 19% (773) had a family income below the poverty threshold. There were increased odds of self-reported poor vision among Black (odds ratio [OR], 2.85; 95% CI, 2.00-4.05; P < .001), Mexican American (OR, 2.83; 95% CI, 1.70-4.73; P < .001), and low-income (OR, 2.44; 95% CI, 1.63-3.65; P < .001) adolescent children. Similarly, there were increased odds of visual acuity worse than 20/40 in the better-seeing eye among Black (OR, 2.13; 95% CI, 1.41-3.24; P = .001), Mexican American (OR, 2.13; 95% CI, 1.39-3.26; P = .001), and non-US citizen (OR, 1.96; 95% CI, 1.10-3.49; P = .02) participants.Conclusions and RelevanceIn this nationally representative sample from 2005 to 2008, adolescent children identifying as Black, Mexican American, low-income, or non-US citizen were more likely to report poor subjective visual function and perform worse on objective visual acuity testing. A greater understanding of the underlying etiology of these disparities may yield opportunities for improving vision at the population level.

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

“…Su et al found that lower educational attainment, food insecurity, and having Medicaid were associated with self-reported visual difficulty. Ko et al found that poverty and having less than a high school education were associated with BCVA among adults and Adomfeh et al found that race, ethnicity, and not being a US citizen were associated with presenting vision impairment among adolescents. Lower incomes and lower levels of education have also been associated with increased odds of diabetic retinopathy …”

“…Studies investigating how social determinants of health (SDOH) affect vision loss suggest that race and ethnicity, income, educational attainment, and food security are associated with vision outcomes . However, with a few exceptions, these studies rely on self-reported data.…”

“…tudies investigating how social determinants of health (SDOH) affect vision loss suggest that race and ethnicity, income, educational attainment, and food security are associated with vision outcomes. [1][2][3][4][5][6] However, with a few exceptions, 1,4,5 these studies rely on self-reported data. Selfreported data are collected more frequently than examinationbased data and the sample size can support state and county estimates.…”

A Qualitative Assessment of the Experiences with Eye Health and Barriers to Eyeglasses among U.S. Youth

“…For example, in the 2005 to 2008 National Health and Nutrition Examination Survey cohort, the most recent cohort to include both visionrelated questionnaires and eye examinations of adolescents, 12-to 18-year-olds who identified as Black, Mexican American, lowincome, and non-U.S. citizens were more likely to have worse subjective and objective visual functioning. 29 Because youth value their eyesight highly, eye care programs that improve access for marginalized youth, such as high school-based eye clinics, may help to address these external barriers. 30 School-based vision programs may also improve students' academic performance.…”

“…Although youth in this study identified appearance, cost, inconvenience, and discomfort as key barriers to eyeglasses, epidemiologic studies have found additional socioeconomic barriers to eye care. For example, in the 2005 to 2008 National Health and Nutrition Examination Survey cohort, the most recent cohort to include both vision-related questionnaires and eye examinations of adolescents, 12- to 18-year-olds who identified as Black, Mexican American, low-income, and non-U.S. citizens were more likely to have worse subjective and objective visual functioning 29 . Because youth value their eyesight highly, eye care programs that improve access for marginalized youth, such as high school–based eye clinics, may help to address these external barriers 30 .…”