Attributes Associated with Eye Care Use in the United States: A Meta-Analysis

Abstract

Objective To model the factors that are associated with the use of eye care services among the United States population with and without diabetes, stratifying by age group. Design Meta-analysis. Participants We analyzed data from three datasets: the Behavioral Risk Factors Surveillance System combined years 2006-2009, the National Health and Nutrition Examination Survey combined years 2005-2008, and the National Health Interview Survey year 2008. For all three datasets, we analyzed data from all survey participants aged 40 or older who participated in vision-related survey modules. Methods We performed multivariate logistic regression analyses to assess associations between any eye care utilization within the previous year and 14 indicators of patient demographics and health. We estimated separate regressions for persons with and without diabetes stratified by age group. We combined estimates across datasets using a random effects model estimated using Markov Chain Monte Carlo algorithms. Main Outcome Measures Use of eye care in the previous year and personal factors associated with eye care use. Results Annual eye care utilization rates ranged from 46% to 51% in participants without diabetes and 64% to 72% in participants with diabetes. For people with and without diabetes, health insurance, an eye disease diagnosis, and higher income were associated with higher odds of eye care utilization. Being male was associated with lower odds of eye care utilization in some diabetes status and age group categories. Other variables, such as more education, being married, black race, Hispanic/Latino ethnicity, health status, heavy drinking, and limited ability to read small print were associated with eye care utilization in only some diabetes status and age group categories. Conclusions Our findings indicate that economic and ocular health factors are associated with the greatest odds of annual eye care utilization. Access to health insurance and income levels greater than $35,000 United States Dollars (value at the time of interview), are associated with eye care utilization, independent of other demographic factors.

Gaps in Receipt of Regular Eye Examinations among Medicare Beneficiaries Diagnosed with Diabetes or Chronic Eye Diseases

“…In contrast to earlier studies, 14, 31, 37, 38 we found little positive effect of educational attainment and income on regular receipt of eye exams. The reasons could be that educational attainment and income work through other channels, including higher cognitive function, better health, better awareness of signs and symptoms of poor health, and more comprehensive health insurance coverage, all of which were explicitly measured in this study.…”

“…This result, although unexpected, is not out of line with the current literature as several studies have shown that black race is a statistically significant predictor of eye care use among persons aged 40 – 64 but not 65 or older. 30, 31 Educational attainment primarily made a difference to receipt of eye exams during follow-up in our univariate analysis.…”

Prevalence and determinants of undiagnosed diabetic retinopathy and vision-threatening retinopathy in a multiethnic Asian cohort: the Singapore Epidemiology of Eye Diseases (SEED) study

“…Eye-care usage rates were low in our study, with only 24.7% of diabetic individuals with visual aids attending yearly eye checks. This is much lower than that of the USA, where a meta-analysis15 in 2013 showed that annual eye-care rates ranged from 64% to 72%. Another surprising finding in our study was that 78.1% of those who were aware of their visual deterioration had undiagnosed DR, and were likely not accessing eye-care services.…”

Variations and Trends in Health Burden of Visual Impairment Due to Cataract: A Global Analysis

“…Even in the United States, annual use of eye services was significantly associated with levels of educational attainment after adjusting for other factors. [32][33][34] A randomized controlled trial demonstrated that educational interventions can successfully increase the uptake of cataract surgery. 35 Sex differences in the health burden of cataract vision loss were significant for each age group.…”