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Factors Associated With Ocular Health Care Utilization Among Hispanics/Latinos Results From an Ancillary Study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Laura A. McClure, MSPH1; D. Diane Zheng, MS2; Byron L. Lam, MD3; Stacey L. Tannenbaum, PhD1; Charlotte E. Joslin, OD, PhD1; Sonia Davis, DrPH5; Daniel López-Cevallos, PhD6,7; Marston E. Youngblood Jr, MPH5; Zhu-Ming Zhang, MD8; Claudia Pulido Chambers, BPh9; David J. Lee, PhD10
[+] Author Affiliations
1Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida
2Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
3Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida
5Department of Biostatistics–Collaborative Studies Coordinating Center, Gillings School of Public Health, University of North Carolina at Chapel Hill
6Center for Latino/a Studies and Engagement, Oregon State University, Corvallis
7School of Public Health, Universidad San Francisco de Quito, Quito, Ecuador
8Epidemiological Cardiology Research Center, Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina
9Department of Psychology, Miller School of Medicine, University of Miami, Miami, Florida
10Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida
JAMA Ophthalmol. 2016;134(3):320-329. doi:10.1001/jamaophthalmol.2015.5842.
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Importance  Regular ocular care is critical to early detection and prevention of eye disease and associated morbidity and mortality; however, there have been relatively few studies of ocular health care utilization among Hispanics/Latinos of diverse backgrounds.

Objective  To examine factors associated with ocular health care utilization among Cuban, Central American, and South American Hispanics/Latinos in a cohort study.

Design, Setting, and Participants  An ancillary study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) evaluating ocular health, knowledge, risk factors, and health care use was conducted with 1235 HCHS/SOL participants (aged ≥40 years) at the Miami, Florida, study site. Data were collected from October 17, 2011, to September 30, 2013, and analyses were conducted from May 28, 2014, to March 18, 2015. Descriptive and multivariable logistic regression analyses were performed for 3 ocular health care outcomes. Regression models were built sequentially with variables conceptually grouped according to Andersen’s Behavioral Model of Health Services Use.

Main Outcomes and Measures  Ever having an eye examination, having an eye examination performed within the past 2 years, and difficulty obtaining needed eye care in the past year.

Results  Of the 1235 participants, 478 were men and 757 were women, and they had a mean (SD) age of 53.6 (8.1) years. Those who never had insurance were less likely to have had an eye examination (with data reported as odds ratios [95% CIs]) ever, 0.19 (0.07-0.53) and in the past 2 years, 0.22 (0.15-0.33) and were more likely to have had difficulty obtaining needed eye care in the past year (3.72 [1.75-7.93]). Those with less than excellent or good self-rated eyesight were less likely to ever have had an eye examination (0.26 [0.12-0.56]) and more likely to have had difficulty obtaining care (3.00 [1.48-6.11]). Men were less likely to ever have had an eye examination (0.31 [0.18-0.53]). Older (55-64 years) Hispanics/Latinos (3.04 [1.47-6.31]) and those with a high school degree or general educational development certification (2.06 [1.02-4.13]) or higher levels of education (4.20 [2.12-8.30]) were more likely to ever have had an eye examination. Finally, those living in the United States for more than 15 years (0.42 [0.21-0.82]) were less likely to have had difficulty obtaining care.

Conclusions and Relevance  Our findings suggest that increasing insurance coverage, decreasing the costs of care, and increasing the availability of care for Hispanics/Latinos with poor self-rated eyesight are relevant issues to address to improve ocular health care use among Hispanics/Latinos of diverse backgrounds.

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