Abstract
Purpose :
Adherence to recommended annual or biennial diabetic eye exams can prevent vision loss from diabetes. Successful diabetes management including eye care involves a high degree of health literacy and diabetes-specific knowledge. Diabetes-specific health literacy is likely particularly important among older adults who must simultaneously manage other chronic diseases. This study evaluates the role of diabetes-specific health literacy in adherence to diabetic eye exams in a nationally representative sample of older American adults.
Methods :
Respondents with self-reported type 2 diabetes mellitus from the Health and Retirement Study (HRS) 2003 Diabetes Study and HRS 2002 Core survey were included. The main outcome was having an eye exam within the past year. The secondary outcome for sensitivity analysis was having an exam within the past two years. The main explanatory variable was diabetes-specific health literacy, an index based on how well respondents understood a series of 10 diabetes care regimen items (e.g., taking insulin, reading nutrition labels). Poisson regression models with robust sandwich variance estimator were constructed to estimate the risk ratio (RR) of diabetes-specific health literacy on adherence to diabetic eye exams, adjusted for age, gender, race and ethnicity, education status, household income, baseline eyesight, and the total illness burden index. Chi-squared tests and Wilcoxon rank sum tests were used to compare groups. All analyses incorporated HRS survey weights.
Results :
The analysis included 2060 respondents. Those who had an eye exam within the past year had a higher diabetes-specific health literacy index (mean 3.40 [range 3.00, 3.90] vs. 3.10 [2.80, 3.60], p<0.001). On multivariate analysis, having a higher diabetes-specific health literacy index was associated with increased likelihood of an eye exam within the past year (RR 1.14 [95% confidence interval (CI) 1.04, 1.24], p=0.006). On sensitivity analysis, the association was borderline (RR 1.05 [95% CI 1.00, 1.10], p=0.07).
Conclusions :
In an older population of type 2 diabetics, having more diabetes-specific health literacy was associated with increased adherence to diabetic eye exams. This suggests that improving disease-specific health literacy skills could be a means by which to promote vision saving diabetic eye examinations.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.