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Kangping Cui, Graham Eric Trope, Yvonne M Buys, Christina Chan, Kednapa Thavorn, Yaping Jin; Low Utilization of Eye Care Providers by Newfoundland and Labrador Seniors: Barriers and Vision Health Outcomes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5562.
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A prior study revealed significantly lower use of eye care providers in Newfoundland and Labrador (NFLD) than other Canadian provinces. We examined factors associated with this low use and evaluated vision health outcomes.
Descriptive analyses with 95% confidence intervals (CI) were performed using self-reported data from Caucasians aged 65+ who participated in the Canadian Community Health Survey Healthy Aging 2008/09 (n=14,925).
The NFLD government, along with PEI, NB, and SK, does not insure seniors without eye disease for routine eye exams. All other Canadian provinces insure seniors regardless of eye conditions. Among people without self-reported glaucoma, cataracts and diabetes, the use of eye care providers in NFLD (36.3%) was the lowest compared to provinces with (50.7%, p<0.05) and without (42.2%, p>0.05) insured eye exams. Among seniors with an eye disease, who are insured in all provinces, use in NFLD (63.1%) was still lower than other provinces (69.4%-71.3%, p>0.05). Lower levels of socioeconomic status and living in non-urbanized areas were associated with reduced use of eye care providers across Canada. Compared to the national average, NFLD seniors had significantly lower levels of education (46.4% vs. 57.8% for post-secondary education), income (11.9% vs. 21.5% for earning above the 70th national income percentile) and urban dwelling (59.4% vs. 81.1%). After adjusting for confounding effects, seniors in NFLD were 15% (prevalence ratio [PR] 0.85, 95% CI 0.77-0.94) and 9% (PR 0.91, 95% CI 0.82-1.02) less likely to use an eye care provider than those in provinces with and without government-insured routine eye exams. The prevalence of self-reported glaucoma was significantly lower in NFLD (3.8%) than in provinces with (7.0%) and without (6.7%) government-insured routine eye exams. The same was true for self-reported cataracts: 16.7% in NFLD vs. 23.2% in insured provinces. The prevalence of uncorrectable vision loss (i.e. unable to see close or distance with eyeglasses) was higher in NFLD than in insured provinces (4.0% vs. 3.5%, p>0.05).
Lack of government insurance, low levels of income and education, living in non-urbanized areas may contribute to the underutilization of eye care providers in NFLD. This low utilization seems to be associated with reduced detection of eye disease and increased prevalence of uncorrectable vision loss.
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