Article
Disparities in Eye Care Utilization Among the United States Adults With Visual Impairment: Findings From the Behavioral Risk Factor Surveillance System 2006-2009

https://doi.org/10.1016/j.ajo.2011.09.025Get rights and content

Purpose

To estimate the prevalence of annual eye care among visually impaired United States residents aged 40 years or older, by state, race/ethnicity, education, and annual income.

Design

Cross-sectional study.

Methods

In analyses of 2006-2009 Behavioral Risk Factor Surveillance System data from 21 states, we used multivariate regression to estimate the state-level prevalence of yearly eye doctor visit in the study population by race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and other), annual income (≥$35 000 and <$35 000), and education (< high school, high school, and > high school).

Results

The age-adjusted state-level prevalence of yearly eye doctor visits ranged from 48% (Missouri) to 69% (Maryland). In Alabama, Colorado, Indiana, Iowa, New Mexico, and North Carolina, the prevalence was significantly higher among respondents with more than a high school education than among those with a high school education or less (P < .05). The prevalence was positively associated with annual income levels in Alabama, Georgia, New Mexico, New York, Texas, and West Virginia and negatively associated with annual income levels in Massachusetts. After controlling for age, sex, race/ethnicity, education, and income, we also found significant disparities in the prevalence of yearly eye doctor visits among states.

Conclusion

Among visually impaired US residents aged 40 or older, the prevalence of yearly eye examinations varied significantly by race/ethnicity, income, and education, both overall and within states. Continued and possibly enhanced collection of eye care utilization data, such as we analyzed here, may help states address disparities in vision health and identify population groups most in need of intervention programs.

Section snippets

Data Source

The BRFSS collects data through continuous, random digit-dialed surveys of noninstitutionalized US civilians aged 18 years or older. Surveys are conducted by all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam. Survey participants are selected through a multistage cluster-design procedure. The BRFSS is de-identified publicly available data, exempt from institutional review board (IRB) approval. Details about its purpose, sampling design, data collection, and

Results

The prevalence of moderate to severe visual impairment among US adults aged 40 years and older was 15.5% in 2006–2009. Of survey participants who reported moderate to severe visual impairment, 26.5% were aged 65 or older, 72.3% were non-Hispanic whites, and almost 50% had more than a high school education and an annual income ≥$35 000 (Table 1). Overall, approximately 58% (95% confidence interval [CI] = 57%-59%) reported having visited an eye doctor within the previous year; by state, the

Discussion

Using 2006–2009 BRFSS data, we found that the prevalence of eye doctor visits within the previous year among US residents aged 40 or older with moderate to severe vision impairment varied among states participating in the surveys, as well as by race/ethnicity, education, and income.

Prevalence rates were lowest in Colorado, Missouri, and New Mexico, possibly at least in part because of relatively low population densities in these states. Results from previous studies have shown that people who

Chiu-Fang Chou, DrPH, is a Health Services Researcher at the US Centers for Disease Control and Prevention for the Ginn Group, and an adjunct assistant professor at University of Illinois at Chicago (UIC). She received a doctorate in public health from the Division of Health Policy and Administration at UIC. Her research interests emphasize vision health, chronic disease, health workforce, health disparities, global health, population health, preventive care, as well as the health surveillance

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      Citation Excerpt :

      Our study results may be difficult to compare to prior studies7,13 because of methodologic differences and use of alternate data sources. County-level educational attainment and geographies with a lower proportion of adults experiencing poverty or lower MDI were positively associated with increased service usage, which corroborates prior work.12,13 Additionally, a higher urban-influence code (which would indicate smaller, less populated areas with less metropolitan adjacency) was associated with usage.

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    Chiu-Fang Chou, DrPH, is a Health Services Researcher at the US Centers for Disease Control and Prevention for the Ginn Group, and an adjunct assistant professor at University of Illinois at Chicago (UIC). She received a doctorate in public health from the Division of Health Policy and Administration at UIC. Her research interests emphasize vision health, chronic disease, health workforce, health disparities, global health, population health, preventive care, as well as the health surveillance system.

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