Abstract
Purpose: :
In Canada the costs of annual eye examinations provided to the elderly by optometrists and ophthalmologists are not uniformly covered by government-sponsored health insurance plans. We assessed whether lack of government-funded annual eye examinations resulted in reduced vision health status amongst elderly Canadians.
Methods: :
We compared the prevalence of non refractive vision problems (i.e., unable to see close or distance when wearing glasses or contact lenses) between seniors with and without government-insured annual eye examinations. Data was derived from 24,086 respondents aged 65 years or older participating in the Canadian Community Health Survey 2000/2001.
Results: :
The prevalence of non refractive vision problems was higher in seniors with household incomes under the mid level (7.5%) than in those at mid level or higher (4.3%, p<0.05) and in non-Caucasians (7.5%) compared to Caucasians (4.6%).Amongst Caucasians with a household income under mid level, the prevalence of non refractive vision problems was greater (8.5%, 95% CI 6.8-10.2) in those with no insurance compared to those with insurance (6.4%, 95% CI 5.2-7.6). In Caucasians with household incomes at mid level or higher, the prevalence was similar between those with (4.3%) and without (3.6%) government-insured annual eye examinations (p>0.05). Compared to elderly Caucasians with mid or high income and living in insured provinces, those residing in provinces with no insurance were associated with 50% higher odds of vision problems (adjusted odds ratio (OR) =1.5, 95% CI 1.1-2.0) if their income was under mid level, but with 30% lower likelihood if their income was at mid level or higher (adjusted OR= 0.7, 95% CI 0.6-1.0). The mean age at diagnosis of glaucoma and cataracts was about 2 years older for people with no insurance versus those with insurance: 68.1 years vs 66.6 years for glaucoma and 72.5 years vs 70.8 years for cataracts.
Conclusions: :
Lack of government funded annual eye examinations is associated with increased levels of non refractive vision problems amongst the low-income elderly. The negative effect of lack of government-insured annual eye examinations on the risk of vision problems is buffered by high household income.
Keywords: clinical (human) or epidemiologic studies: risk factor assessment • clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: prevalence/incidence