Abstract
Purpose :
To stratify and assess vision care utilization data from the National Survey of Children’s Health (NSCH) by demographic and social determinants of health (SDOH) measures.
Methods :
Parent-reported data from the 2016-2020 NSCH were used to identify the vision test provider type (PT). PT options included school, primary care provider/pediatrician (PCP), eye care provider(s) (ECP), clinic or health center (HC), or other. Data were stratified by age, sex, race, house household income, household education level, reported childhood adverse experiences (ACE), birthright citizenship in the United States (U.S.), insurance status, tobacco use in their home, and sidewalks in their neighborhood. Weighted unadjusted prevalence values and 95% confidence intervals were calculated. Within-year comparisons between each SDOH measure by each PT were performed using chi square tests. To adjust for multiple comparisons a significance value of <0.0001 was used. All 5 years of data were pooled to quantify associations between SDOH measures and reported PT using adjusted multinomial logistic regression.
Results :
ECP were the most common vision care PT, followed by PCP, school, HC, and other for each of the 5 years. All SDOH measures were found to have a significant association on reported PT. Children age 0-11, males, Black/Hispanic/other reported children, households <400% of the Federal Poverty Level (FPL), household education level of high school or less, or non-U.S. birthright citizens were more likely to visit a HC rather than an ECP. Children age 0-11, females, household education at the college level, children with 0 or 1 ACE, those in a non-tobacco household, or those in non-sidewalk neighborhoods were more likely to report vision care by a PCP rather than ECP. Children age 0-11, Black/Hispanic/Asian children, households between 200-399% of the FPL, uninsured children, and those living in tobacco use households were more likely to report utilizing schools compared to ECP.
Conclusions :
SDOH were associated with significant differences in the reported PT. ECP were the most common source of a vision care among PTs, but several measures reported frequent testing by PCP and HC. By understanding how the pediatric population interacts with the vision health system, interventions can be developed to address unmet need, provider distribution, and improve care.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.