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Varshini Varadaraj, Kevin D Frick, Jinan Saaddine, David S Friedman, Bonnielin K Swenor; Trends in eyecare access and affordability: The National Health Interview Survey (NHIS) 2008–2016. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1598.
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© ARVO (1962-2015); The Authors (2016-present)
To examine trends in accessing and affording eyecare in the United States
We analyzed NHIS data from 2008–2016. Outcome measures included visits to an eye doctor and inability to afford eyeglasses when needed in the past year. Vision impairment (VI) was defined as self-reported difficulty seeing despite wearing glasses. Survey logistic regression, adjusted for age, sex, race/ethnicity, VI, education, general health, and poverty-income ratio was used to examine associations between survey year and eyecare outcomes.
In unadjusted analyses, the percent of Americans accessing eyecare remained stable from 2008–2013, but increased from 2014–2016 (p<0.05). The percent of the population reporting difficulty affording glasses increased from 2008–2010, but decreased from 2011–2016 (p<0.05). In fully adjusted models, Americans were less likely to access eyecare from 2009–2014, as compared to 2008, although this estimate was significant only in 2014 (OR=0.92, p=0.002). This pattern reversed in 2015, and by 2016 they were significantly more likely to access eyecare as compared to 2008 (OR=1.06, p=0.04). Similarly, when compared to 2008 they were more likely to report difficulty in affording glasses in 2009 (OR=1.11, p=0.04), and 2010 (OR=1.13, p=0.007), but by 2014 this pattern reversed and they were less likely to report difficulty (2014 OR=0.81; 2015 OR=0.80; 2016 OR=0.69, p<0.001 for all). After adjusting for all covariates and survey year, those with VI, as compared to those without VI, were more likely to access care (OR=1.56) but had greater difficulty affording glasses (OR=3.82) (p<0.001 for both). Similarly, women were more likely to access care (OR=1.46), but also more likely to report difficulty affording glasses (OR=1.62), as compared to men (p<0.001 for both). As compared to Hispanics, whites (OR=1.25), and blacks (OR=1.07), were more likely to access care; and Asians were less likely to have difficulty affording glasses (OR=0.69) (p<0.001 for all).
A pattern of decreased difficulty accessing and affording eyecare was observed from 2014–2016, which may reflect economic recovery after the Great Recession and/or healthcare changes due to the Affordable Care Act and Medicaid expansion. However, marginalized populations (females, ethnic minorities, and those with VI) continue to face difficulties with accessing and/or affording eyecare.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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