Original Investigation | Epidemiology

Eye Care Use Among a High-Risk Diabetic Population Seen in a Public Hospital's Clinics

Paul A. MacLennan, PhD1; Gerald McGwin Jr, PhD1,2,3; Christine Heckemeyer, MD, MSPH4; Virginia R. Lolley, MD3; Sandral Hullett, MD, MSPH4; Jinan Saaddine, MD, MPH5 ; Sundar S. Shrestha, PhD5 ; Cynthia Owsley, PhD, MSPH3
[+] Author Affiliations
1Department of Surgery, School of Medicine, University of Alabama at Birmingham
2Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
3Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
4Jefferson County Health System, Cooper Green Mercy Hospital, Birmingham, Alabama
5 Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA Ophthalmol. 2014;132(2):162-167. doi:10.1001/jamaophthalmol.2013.6046.
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Importance  Little is known regarding eye care use among low-income persons with diabetes mellitus, especially African Americans.

Objective  To investigate eye care use among patients with diabetes who were seen in a county hospital clinic that primarily serves high-risk, low-income, non-Hispanic African American patients.

Design, Setting, and Participants  A retrospective cohort study with 2 years of follow-up examined eye care use among adult patients with diabetes seen in 2007 in an outpatient medical clinic of a large, urban county hospital that primarily serves low-income, non-Hispanic African American patients. Patients with a history of retinopathy and macular edema or a current diagnosis indicating ophthalmic complications were excluded. Eye care use was defined dichotomously as whether or not patients had a visit to the eye clinic for any eye care examination or procedure. We estimated crude and adjusted rate ratios (aRRs) and 95% CIs for the association between eye care use and selected clinical and demographic characteristics.

Results  There were 867 patients with diabetes identified: 61.9% were women, 76.2% were non-Hispanic African American, and 61.4% were indigent, with a mean age of 51.8 years. Eye care utilization rates were 33.2% within 1 and 45.0% within 2 years. For patients aged 19 to 39 years compared with those aged 65 years or older, significantly decreased eye care utilization rates were observed within 1 year (aRR, 0.48; 95% CI, 0.27-0.84) and within 2 years (aRR, 0.61; 95% CI, 0.38-0.99).

Conclusions and Relevance  Overall eye care utilization rates were low. Additional education efforts to increase the perception of need among urban minority populations may be enhanced if focused on younger persons with diabetes.

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