Socioeconomic Disparities Among Adults With Eye Diseases

Lara C. Pullen, PhD

July 19, 2013

Socioeconomic position (SEP) has a significant effect on adult use of eye care services in the United States, according to research by Xinzhi Zhang, MD, PhD, from the National Institute on Minority Health and Health Disparities, National institutes of Health, Bethesda, Maryland, and colleagues.

The researchers published their analysis of the National Health Interview Survey (NHIS) online July 18 in JAMA Ophthalmology. The findings are consistent with the 2011 National Healthcare Quality & Disparities Reports, which concluded that although healthcare quality is improving, access and disparities are not.

The analysis included individuals who were aged 40 years or older and who had reported age-related eye disease, including age-related macular degeneration, cataract, diabetic retinopathy, or glaucoma.. The sample included 3586 participants in 2002 and 3104 participants in 2008.

"We used data from the NHIS, a large, complex in-person population survey. As an ongoing survey, it allows us to obtain population-based national estimates to observe changes over time and the potential impact of societal transformation. Such national survey data can be used to assess and monitor disparities in the use of eye care services in the United States," the authors write.

They acknowledge, however, that their study was limited in that it did not account for geographic location or other factors associated with income and education.

In 2002, individuals with age-related eye disease and a poverty-income ratio (PIR) less than 1.50 were significantly less likely than those with a PIR of 5.0 or higher to report visiting an eye care provider (62.7% vs 80.1%; P < .001). In 2008, the slope index of inequality showed a significant difference in eye care provider visits across the levels of PIR (21.8; P = .01). Adjustments were made for age, sex, race/ethnicity, and health insurance.

Access to and use of effective and appropriate eye care is important for the reduction of vision-related morbidity and mortality. SEP differences in healthcare use may affect health outcomes and cause health disparities.

"In this study, we found considerable differences in the use of eye care services by SEP; such use decreased progressively with increasing socioeconomic disadvantage. This finding adds to the general literature on the strong influence of socioeconomic circumstance on an individual's health status. Moreover, a close analysis of the association between the use of eye care services and SEP showed that the inequalities in use, between the extremes of the income and education distributions and averaged across the cumulative distributions of the population, were sustained from 2002 to 2008," he authors write.

In many cases, both income and educational level are social determinants of health, suggesting that the disparity problem should be addressed from both the health policy and social policy perspectives. Thus, any actions would benefit from a better understanding of the relationship between income and education inequalities and health-seeking behavior.

"Not surprisingly, we found that adults with at least a high school education were relatively more likely to use eye care services than those with less education. A 2005 study indicated that 'no reason to go' is the major reason for persons not to see an eye care professional; this emphasizes the importance of health awareness education to improve the use of eye care services," the authors write.

"Given that income and educational level are important social determinants of health, both society and individuals have the responsibility and capability to influence and help reduce such disparities," Dr. Zhang wrote in an email to Medscape Medical News. "Eye care providers, as well as primary care providers, should more proactively educate patients with low [socioeconomic status] about the importance of regular eye examination. More community-participated public health interventions to reduce eye care disparities are needed to further engage both patients and physicians."

The authors have disclosed no relevant financial relationships.

JAMA Ophthalmol. Published online July 18, 2013. Abstract


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