Disparities in Eye Care Utilization Among the United States Adults With Visual Impairment: Findings From the Behavioral Risk Factor Surveillance System 2006-2009

Chou, Chiu-Fang; Barker, Lawrence; Crews, John E.; Primo, Susan A.; Zhang, Xinzhi; Elliott, Amanda; Bullard, Kai McKeever; Geiss, Linda S.; Saaddine, Jinan B.

doi:10.1016/j.ajo.2011.09.025

Cited by 73 publications

(60 citation statements)

References 26 publications

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“…29-32 We also found that better-educated patients had higher odds of eye-care utilization, consistent with previous studies. 32-36 Similar to other studies, 32-34,37-38 black patients had decreased odds of eye-care visits, relative to whites, although blacks often have more visual impairment. 28,39,40 Such disparities are particularly disconcerting because among the greatest HCQ/CQ users, black patients had substantially reduced odds of eye-care visits.…”

Section: Discussionsupporting

confidence: 72%

Regular Examinations for Toxic Maculopathy in Long-term Chloroquine or Hydroxychloroquine Users

et al. 2014

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According to evidence-based, expert recommendations, long-term users of chloroquine or hydroxychloroquine sulfate should undergo regular visits to eye care providers and diagnostic testing to check for maculopathy.OBJECTIVE To determine whether patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) taking chloroquine or hydroxychloroquine are regularly visiting eye care providers and being screened for maculopathy. DESIGN, SETTING, AND PARTICIPANTSPatients with RA or SLE who were continuously enrolled in a particular managed care network for at least 5 years between January 1, 2001, and December 31, 2011, were studied. Patients' amount of chloroquine or hydroxychloroquine use in the 5 years since the initial RA or SLE diagnosis was calculated, along with their number of eye care visits and diagnostic tests for maculopathy. Those at high risk for maculopathy were identified. Logistic regression was performed to assess potential factors associated with regular eye care visits (annual visits in Ն3 of 5 years) among chloroquine or hydroxychloroquine users, including those at highest risk for maculopathy.MAIN OUTCOMES AND MEASURES Among chloroquine or hydroxychloroquine users and those at high risk for toxic maculopathy, the proportions with regular eye care visits and diagnostic testing, as well as the likelihood of regular eye care visits. RESULTS Among 18 051 beneficiaries with RA or SLE, 6339 (35.1%) had at least 1 record of chloroquine or hydroxychloroquine use, and 1409 (7.8%) had used chloroquine or hydroxychloroquine for at least 4 years. Among those at high risk for maculopathy, 27.9% lacked regular eye care visits, 6.1% had no visits to eye care providers, and 34.5% had no diagnostic testing for maculopathy during the 5-year period. Among high-risk patients, each additional month of chloroquine or hydroxychloroquine use was associated with a 2.0% increased likelihood of regular eye care (adjusted odds ratio, 1.02; 95% CI, 1.01-1.03). High-risk patients whose SLE or RA was managed by rheumatologists had a 77.4% increased likelihood of regular eye care (adjusted odds ratio, 1.77; 95% CI, 1.27-2.47) relative to other patients. CONCLUSIONS AND RELEVANCEIn this insured population, many patients at high risk for maculopathy associated with the use of chloroquine or hydroxychloroquine are not undergoing routine monitoring for this serious adverse effect. Future studies should explore factors contributing to suboptimal adherence to expert guidelines and the potential effect on patients' vision-related outcomes.

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Section: Discussionsupporting

confidence: 72%

Regular Examinations for Toxic Maculopathy in Long-term Chloroquine or Hydroxychloroquine Users

et al. 2014

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“…Several studies on inequality have indicated that blindness is more prevalent in poor communities (17)(18)(19); gender disparity in eye diseases and access to eye care services has also been reported (20)(21)(22). Although reports of disparity in the frequency of utilization of eye care services (23)(24)(25) are available, we found no report on the role of economic inequality in utilization of eye care services. The goals of vision 2020 will undoubtedly be made easier by understanding the extent of this disparity and its determinants.…”

Section: Introductioncontrasting

confidence: 54%

“…The findings presented above show that striving to equalize the utilization of men and women to eye care services will be more effective in battling economic inequality than would efforts to equalize level of education among different economic groups of the population. Numerous studies have used regression models to investigate the role of income in utilization of eye care services (23)(24)(25). To the best of our knowledge, no study has been done regarding the economic gap in eye care utilization and its determinant.…”

Section: Discussionmentioning

confidence: 99%

Economic inequality in eye care utilization and its determinants: a Blinder–Oaxaca decomposition

Emamian

Zeraati

Majdzadeh

et al. 2014

Int J Health Policy Manag

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Background: The current study aimed to determine eye care utilization, to assess the role of economic inequality in the utilization of eye care services, and to identify its determinants in Shahroud, North of Iran. Methods: Of the 6,311 invited people, 5,190 (82.24%) individuals aged 40 to 64 years old participated in the study. A history of a visit by an ophthalmologist or optometrist was considered as eye care utilization. The gap between low-and high-economic groups was decomposed into its determinants using the Oaxaca decomposition method. Results: Among the participants, 16.32% [95% Confidence Intervals (CI)= 15.31-17.33%] had never been examined by an ophthalmologist or optometrist, and 30.94% (95% CI= 29.69-32.20%) had not undergone an eye examination in the past 5 years. This negative history was significantly higher among female subjects [Odds Ratio (OR)= 1.79, 95% CI= 1.51-2.14], the low-economic group (OR= 2.33, 95% CI= 1.90-2.87), the visually impaired (OR= 1.41, 95% CI= 1.05-1.90), and the uninsured (OR= 1.93, 95% CI= 1.45-2.58). The negative history of eye examination decreased with increasing in age (OR= 0.94, 95% CI= 0.93-0.96) and education (OR= 0.94, 95% CI= 0.92-0.96). In this study, 24.72% (95% CI= 22.30-27.14) of the low-economic group and 9.94% (95% CI= 8.75-11.14) of the high-economic group had no history of eye examination. Decomposition of the gap between the two economic groups showed that education and gender were the most important determinants of inequality. Conclusion: A considerable percentage of adults, even those with visual impairment, do not receive appropriate eye care. There is a definite economic inequality in the community for which poverty per se could be the major cause.

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“…Medicare attenuates disparities in health care utilization for services covered by Medicare by minimizing the effect of economic access variables (e.g., education, income, wealth, health insurance; Dunlop, Manheim, Song, & Chang, 2002; Shih, Zhao, & Elting, 2006; also Dunlop et al, 2002; Shih et al, 2006). For example, rates of vision care, which is similar to hearing testing in its coverage by Medicare, do not differ among older adults by race/ethnicity (Chou et al, 2012). Another explanation may be differences in physician referral rates by race/ethnicity, which may affect referrals for a range of services, from preventive care to invasive procedures (Goulart et al, 2013; LaVeist, Morgan, Arthur, Plantholt, & Rubinstein, 2002).…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic and Socioeconomic Disparities in Hearing Health Care Among Older Americans

et al. 2015

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Objective Hearing impairment is highly prevalent, but little is known about hearing health care among older minority adults. Method We analyzed nationally representative, cross-sectional data from 1,544 older adults ≥70 years with audiometry and hearing care data from the 2005-2006 and 2009-2010 National Health and Nutritional Examination Surveys. Results After adjusting for age and speech frequency pure tone average, Blacks (odds ratio [OR] = 1.68, vs. Whites) and those with greater education (OR = 1.63, ≥college vs.

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Disparities in Eye Care Utilization Among the United States Adults With Visual Impairment: Findings From the Behavioral Risk Factor Surveillance System 2006-2009

Cited by 73 publications

References 26 publications

Regular Examinations for Toxic Maculopathy in Long-term Chloroquine or Hydroxychloroquine Users

Regular Examinations for Toxic Maculopathy in Long-term Chloroquine or Hydroxychloroquine Users

Economic inequality in eye care utilization and its determinants: a Blinder–Oaxaca decomposition

Racial/Ethnic and Socioeconomic Disparities in Hearing Health Care Among Older Americans

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