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Original Investigation | Socioeconomics and Health Services

Socioeconomic Disparity in Use of Eye Care Services Among US Adults With Age-Related Eye Diseases:  National Health Interview Survey, 2002 and 2008

Xinzhi Zhang, MD, PhD1; Gloria L. Beckles, MD, MSc2; Chiu-Fang Chou, PhD2; Jinan B. Saaddine, MD, MPH2; M. Roy Wilson, MD, MPH1; Paul P. Lee, MD, JD3; Nair Parvathy, MD2; Asel Ryskulova, MD4; Linda S. Geiss, MS2
[+] Author Affiliations
1National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
2National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
3Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
4National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
JAMA Ophthalmol. 2013;131(9):1198-1206. doi:10.1001/jamaophthalmol.2013.4694.
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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.

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