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Patricia Ple-plakon, Chris Andrews, David Musch, Paul Lee, Joshua Stein; Despite Possessing Health Insurance, Large Disparities Exist in Likelihood of Visits to Eye Care Providers Across U.S. Sociodemographic Groups. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4544.
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To determine whether race, education, and income impact the likelihood of visiting an eye care provider among a nationwide sample of enrollees in a U.S. managed care plan.
Reviewed claims data of all enrollees ≥21 years old in a U.S. managed care network who had eye care from 2001-2011 to determine the proportion visiting eye care providers yearly. Performed logistic regression to determine the impact of sociodemographic factors on the likelihood of visits to various eye care providers.
Among 9.8 million enrollees, those with racial data included 80.6% white, 6.1% black, 8.7% Latino, 3.5% Asian American and 1.1% other; 30.4% had ≤ high school(HS) diploma and 20.3% had ≥college degree; 5.5% had income <$30K and 6.6% had income >$125K. Adjusting for other factors, the odds of visiting an ophthalmologist were 3% lower among blacks (OR=0.97) and 9% higher among Asian Americans (OR=1.09) relative to whites. Racial minorities were less likely to visit an optometrist relative to whites (ORblack=0.80,ORlatino=0.71,ORasian=0.80). Compared to those with HS diploma, enrollees with college degrees had 35% higher odds of visiting an ophthalmologist (OR=1.35) and equal odds of visiting an optometrist (OR=1.01). Compared to those earning <$30K, those earning >$125K had 19% higher odds of visiting an ophthalmologist (OR=1.19) and 23% lower odds of visiting an optometrist (OR=0.77). Controlling for major ocular comorbidities, the most affluent and well-educated whites, relative to the least affluent and less-educated blacks, had 120% higher odds of visiting an ophthalmologist (OR=2.2) and 24% lower odds of visiting an optometrist (OR=0.76). All SEs of ORs ≤0.02. Further analyses compared probabilities of visits to eye care providers among the most affluent and educated whites versus the least affluent and educated blacks with glaucoma, cataract, ARMD, and diabetic retinopathy.
Race, education, and wealth dramatically impact the probability of seeking eye care by ophthalmologists and optometrists, despite all enrollees having health insurance. Income and education had a greater effect than race. This pattern of eye care utilization puts racial minorities and people of lower socioeconomic status at higher risk for many sight-threatening ocular diseases, thus creating important implications for policy-making and future resource allocation.
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