Socioeconomic disparity in use of eye care services among US adults with age-related eye diseases: National Health Interview Survey, 2002 and 2008.

IMPORTANCE: Individuals with age-related eye disease (ARED) need to use eye care services for detection, assessment, and care at regular intervals. OBJECTIVE: To explore the association between socioeconomic position (SEP) and use of eye care services among US adults with self-reported ARED during 2002 and 2008. DESIGN: Data were from the National Health Interview Survey 2002 and 2008. We used multiple logistic regression to estimate predictive margins, controlling for other factors, and we used the slope index of inequality to measure the relationship between SEP and use of eye care services across the entire distributions of poverty-income ratio (PIR) and educational attainment. SETTING: A cross-sectional, nationally representative sample of adults, with prevalence estimates weighted to represent the civilian, noninstitutionalized US population. PARTICIPANTS: The sample included US participants in the 2002 (n = 3586) and the 2008 (n = 3104) National Health Interview Survey who were at least 40 years old and reported any ARED (age-related macular degeneration, cataract, diabetic retinopathy, or glaucoma). MAIN OUTCOMES AND MEASURES: Use of eye care services; SEP was measured by the PIR and educational attainment. RESULTS: In 2002, persons with ARED and a PIR of less than 1.50 were significantly less likely than those with a PIR of at least 5 to report visiting an eye care provider (62.7% vs 80.1%; P < .001) or undergoing a dilated eye examination in the past 12 months (64.3% vs 80.4%; P < .001), after adjustment for other factors. Similarly, persons with less than a high school education were less likely than those with at least a college education to report a visit to an eye care provider (62.9% vs 80.8%; P < .001) or dilated eye examination (64.8% vs 81.4%; P < .001). In 2002, the slope index of inequality showed statistically significant differences for eye care provider visits across the levels of education (24.4; P = .006), and in 2008, it showed a significant difference for eye care provider visits across the levels of educational attainment (25.2; P = .049) and PIR (21.8; P = .01). CONCLUSIONS AND RELEVANCE: Significant differences in the use of eye care services by SEP persist among US adults with eye diseases.

Surveillance of disparities in vision and eye health in the United States: an expert panel's opinions.

PURPOSE: To define surveillance approaches and metrics to capture the burden of vision health disparities and to identify properties of a surveillance system to guide public health interventions. DESIGN: Expert panel. METHODS: Analysis of relevant literature and deliberations of expert panel. RESULTS: The panel identified that the purpose of vision surveillance was to link data to public health interventions. Panel members noted the importance of assessing vision through self-reported and performance-based measures. Defined populations should be included in a surveillance system to assess disparities in utilization of eye care and vision loss. The panel suggested that ophthalmic/vision measures should be sustained in national surveys and suggested that a vision surveillance system should be forged among federal agencies. CONCLUSIONS: Employing the 6 outlined strategies would improve vision surveillance and help reach the vision-related objectives of Healthy People 2020.

Vision health disparities in the United States by race/ethnicity, education, and economic status: findings from two nationally representative surveys.

PURPOSE: To assess vision health disparities in the United States by race/ethnicity, education, and economic status. DESIGN: Cross-sectional, nationally representative samples. METHODS: We used national survey data from the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS). Main outcome measures included, from NHANES, age-related eye diseases (ie, age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], glaucoma) and from NHIS, eye care use (ie, eye doctor visits and cannot afford eyeglasses when needed) among those with self-reported visual impairment. The estimates were age- and sex-standardized to the 2000 US Census population. Linear trends in the estimates were assessed by weighted least squares regression. RESULTS: Non-Hispanic whites had a higher prevalence of AMD and cataract surgery than non-Hispanic blacks, but a lower prevalence of DR and glaucoma (all P < .001 in NHANES 2005-2008). From 1999 to 2008, individuals with less education (ie, high school) and lower income (poverty income ratio [PIR] <1.00 vs ≥ 4.00) were consistently less likely to have had an eye care visit in the past 12 months compared with their counterparts (all P < .05). During this period, inability to afford needed eyeglasses increased among non-Hispanic whites and Hispanics (trend P = .004 and P = .007; respectively), those with high school education (trend P = .036), and those with PIR 1.00-1.99 (trend P < .001). CONCLUSIONS: Observed vision health disparities suggest a need for educational and innovative interventions among socioeconomically disadvantaged groups.

Comparing racial and ethnic populations based on Healthy People 2010 objectives.

Objective - The Healthy People 2010 initiative (HP2010) specified objectives for improving the health of the nation, established baseline values, and set specific targets to be achieved by 2010. HP2010 objectives are based on two overarching goals: First, to increase years and quality of life, and second, to eliminate disparities among subgroups of the population. In this report racial and ethnic populations are compared based on progress toward targets, the size of disparities, and changes in disparity for specific sets of objectives. Methods - Progress is measured in terms of movement toward or away from the target between the HP2010 baseline and the most recent data point. Disparities are measured as the percent difference between the rate for the racial and ethnic population with the best or most favorable rate and the rates for the other racial and ethnic populations. Changes in disparity are measured in terms of the percentage point change in the percent difference from the best group rate between the baseline and the most recent data point. Some comparisons can be made based on objectives with data for five populations (American Indian or Alaska Native, Asian, Hispanic or Latino, non-Hispanic black, and non-Hispanic white). Additional comparisons can be made for objectives with data for the three larger populations (Hispanic or Latino, non-Hispanic black, and non-Hispanic white). Results - Differences between populations in progress toward the targets for HP2010 objectives are observed; however, the majority of objectives was moving toward or had reached their targets for each population. Greater differences between racial and ethnic populations are evident in the size of disparities. Disparities for the American Indian or Alaska Native, the Hispanic or Latino and non-Hispanic black populations are greater than those for the Asian and non-Hispanic white populations. Between the baseline and the most recent data point, the number of objectives with increasing disparities was similar to the number of objectives with decreasing disparities and there was no change in disparity for most objectives. In order to achieve the two goals of HP2010, rates must improve and relative differences between populations must be reduced.

Self-reported age-related eye diseases and visual impairment in the United States: results of the 2002 national health interview survey.

OBJECTIVES: We sought to establish national data on the prevalence of visual impairment, blindness, and selected eye conditions (cataract, diabetic retinopathy, glaucoma, and macular degeneration) and to characterize these conditions within sociodemographic subgroups. METHODS: Information on self-reported visual impairment and diagnosed eye diseases was collected from 31,044 adults. We calculated weighted prevalence estimates and odds ratios with logistic regression using SUDAAN. RESULTS: Among noninstitutionalized US adults 18 years and older, the estimated prevalence for visual impairment was 9.3% (19.1 million Americans), including 0.3% (0.7 million) with blindness. Lifetime prevalence of diagnosed diseases was as follows: cataract, 8.6% (17 million); glaucoma, 2.0% (4 million); macular degeneration, 1.1% (2 million); and diabetic retinopathy, 0.7% (1.3 million). The prevalence of diabetic retinopathy among persons with diagnosed diabetes was 9.9%. CONCLUSIONS: We present the most recently available national data on self-reported visual impairment and selected eye diseases in the United States. The results of this study provide a baseline for future public health initiatives relating to visual impairment.