Association of Socioeconomic, Demographic, and Health Care Access Disparities With Severe Visual Impairment in the US

Abstract

ImportanceApproximately 13% of US adults are affected by visual disability, with disproportionately higher rates in groups impacted by certain social determinants of health (SDOH).ObjectiveTo evaluate SDOH associated with severe visual impairment (SVI) to ultimately guide targeted interventions to improve ophthalmic health.Design, Setting, and ParticipantsThis quality improvement study used cross-sectional data from a telephone survey from the Behavioral Risk Factor Surveillance System (BRFSS) that was conducted in the US from January 2019 to December 2020. Participants were noninstitutionalized adult civilians who were randomly selected and interviewed and self-identified as “blind or having serious difficulty seeing, even while wearing glasses.”ExposuresDemographic and health care access factors.Main Outcomes and MeasuresThe main outcome was risk of SVI associated with various factors as measured by odds ratios (ORs) and 95% CIs. Descriptive and logistic regression analyses were performed using the Web Enabled Analysis Tool in the BRFFS.ResultsDuring the study period, 820 226 people (53.07% female) participated in the BRFSS survey, of whom 42 412 (5.17%) self-identified as “blind or having serious difficulty seeing, even while wearing glasses.” Compared with White, non-Hispanic individuals, risk of SVI was increased among American Indian/Alaska Native (OR, 1.63; 95% CI, 1.38-1.91), Black/African American (OR, 1.50; 95% CI, 1.39-1.62), Hispanic (OR, 1.65; 95% CI, 1.53-1.79), and multiracial (OR, 1.33; 95% CI, 1.15-1.53) individuals. Lower annual household income and educational level (eg, not completing high school) were associated with greater risk of SVI. Individuals who were out of work for 1 year or longer (OR, 1.78; 95% CI, 1.54-2.07) or who reported being unable to work (OR, 2.90; 95% CI, 2.66-3.16) had higher odds of SVI compared with the other variables studied. Mental health diagnoses and 14 or more days per month with poor mental health were associated with increased risk of SVI (OR, 1.87; 95% CI, 1.73-2.02). Health care access factors associated with increased visual impairment risk included lack of health care coverage and inability to afford to see a physician.Conclusions and RelevanceIn this study, various SDOH were associated with SVI, including self-identification as being from a racial or ethnic minority group; low socioeconomic status and educational level; long-term unemployment and inability to work; divorced, separated, or widowed marital status; poor mental health; and lack of health care coverage. These disparities in care and barriers to health care access should guide targeted interventions.

Population Prevalence of Vision Impairment in US Adults 71 Years and Older

“…Because the NHATS sample was last replenished in 2015, it may also be underpowered to detect differences between racial and ethnic groups in the multivariable model, an issue that may be resolved with ongoing sample replenishment and oversampling of Black and Hispanic respondents. These findings build on the emerging work that has been published on social determinants of vision health and substantiate the need for additional research to disentangle individual- and community-level factors that shape vision health outcomes and access to eye care.…”

Considerations for Using Large Data Sets to Assess Disparities in Eye Care and Vision Health

“…Data sets may exclude populations from diverse racial and ethnic backgrounds or with low incomes. In the current work, for example, Besagar et al highlight that 76% of the sample were non-Hispanic White. People from racial and ethnic minority backgrounds and people with lower socioeconomic status are disproportionately affected by social risk factors.…”

“…Large data sets, such as the Behavioral Risk Factor Surveillance System, are publicly available, providing a nationwide sample to evaluate health disparities, perform longitudinal surveillance, and identify areas of needed policy interventions. In this current work, the team found that severe visual impairment was associated with identifying as Black/African American, American Indian or Alaska Native, or Hispanic, having depression, being single, having poor economic stability, having low educational attainment, and having poor health care accessibility …”

“…In this current work, the team found that severe visual impairment was associated with identifying as Black/African American, American Indian or Alaska Native, or Hispanic, having depression, being single, having poor economic stability, having low educational attainment, and having poor health care accessibility. 1 While large data sets supplement our understanding of social determinants of health, large data sets have important limitations. 2 Data sets may exclude populations from diverse racial and ethnic backgrounds or with low incomes.…”

“…Besagar et al used the Behavioral Risk Factor Surveillance System, a state-based telephone interview survey coordinated by the US Centers for Disease Control and Prevention, to determine associations of demographic factors, mental health, and social determinants of health with self-reported severe visual impairment. Large data sets, such as the Behavioral Risk Factor Surveillance System, are publicly available, providing a nationwide sample to evaluate health disparities, perform longitudinal surveillance, and identify areas of needed policy interventions.…”