Eye Examination Recency among African American Older Adults with Chronic Medical Conditions

Abstract

Background: Pervasive racial and economic inequalities have a disproportionate impact on health care utilization among African Americans. One area where we see such disparities is in the recency of eye examinations among the economically disadvantaged. However, our current understanding of the barriers and facilitators of eye examinations in underserved African-American older adults is limited. Aims: Building on Andersen’s model of health service use and using an exploratory approach; we tested various demographic, social, and health factors that were associated with eye examination among underserved middle-aged and older adults in South Los Angeles. We examined predisposing characteristics, enabling factors, and need-for-care characteristics. Methods: With a cross-sectional design, we conducted this survey on a convenience sample of (n = 740) non-institutionalized African-American older adults who were 55+ years old and residing in South Los Angeles, CA, USA. Data were collected on demographic factors, continuity of care, access to care, self-rated health, chronic medical conditions, and depressive symptoms. The outcome was recency of eye examination. Multivariate regression was used for data analysis. Results: 59% of the participants had received at least one eye examination during the last 12 months. A total of 17% had an eye examination within the last two years. Notably, 26% of diabetic participants did not have an eye examination within the last two years. One out of four participants indicated that, within the last two years, no provider ever recommended that they receive an eye examination. Age, education, continuity of medical care, accessibility of medical care, satisfaction with medical care, providers’ recommendation for eye examination, self-rated health, and a diagnosis of hypertension and diabetes mellitus were predictors of eye examination recency. Overall, our analysis indicates that these enabling factors accounted for most of the variance in the recency of eye examinations. Conclusion: A large proportion of underserved African-American middle-aged and older adults in South Los Angeles do not comply with the recommended annual eye examination. This is, in part, because about one-third of them have not received an eye exam recommendation from their health care providers. However, a wide range of factors such as age, education, continuity of care, satisfaction with access, self-rated health, and a diagnosis of hypertension and diabetes mellitus, also influence whether or not African-American middle-aged and older adults receive an eye examination. Programs should address a wide range of multi-level factors to tackle this health inequality.

Ocular Hypertension in Blacks

“…These inequities are evident in a 2020 study documenting the recency of eye examinations among black adults over the age of 55. [40] In this study, 13.4% of participants (n = 740) reported having no eye examination in the last five years and nearly 25% had not had an eye exam in the last year. [40] Concerningly, 20% of study participants with diabetes mellitus were not instructed by other healthcare providers to seek annual eye examinations.…”

Examining colorectal cancer screening uptake and health provider recommendations among underserved middle aged and older African Americans

“…The average of these three scores was used, where a higher score indicated of a higher level of satisfaction with quality access to and quality of medical care. 34 The value for Cronbach’s Alpha for this 3-item scale was α = 0.82).…”

Detection of TTR Amyloid in the Conjunctiva Using a Novel Fluorescent Ocular Tracer

“…In the United States, use of eye care is relatively high among older adults. 64 , 65 A recent survey found that approximately 82% of Americans between the ages 50 and 80—an age range that spans the presymptomatic to symptomatic phases of wtATTR-CM and V122I ATTR-CM—had an eye examination within the last two years. 64 Access to eye care professionals is also high for this age group; 90% of the Medicare population lives (USA) within 25 minutes of an ophthalmologist and 14 minutes of an optometrist.…”