The Impact of Insurance and Geographic Location on Ocular Health Knowledge and Literacy

Abstract

Purpose : Recognizing socioeconomic disparities in accessing medical information and health literacy, it is imperative to investigate the effects of these disparities on the ability to benefit from and retain health-related information. This cross-sectional observational study examines disparities in insurance access and regional demographics, seeking to investigate their impact on ocular health literacy across diverse community areas. This study is centered on a cohort of residents from San Antonio (SA) participating in Project Blink's health literacy initiative.

Methods : Comprehensive respondent demographic information, including age, race, insurance coverage, and historical five-digit zip code data, was acquired through a qualitative survey. Pre- and post-surveys incorporating five ocular health questions were conducted to evaluate the correlation between diabetes and ocular health. Inclusion criteria of respondent zip code status was compared against the identified sixteen highest poverty zip codes in SA according to US Internal Revenue Service (IRS). This dataset facilitated quantitative test results analyzed using the paired t-Test method, reported in terms of Hedges' g (Cohen’s d correction) with associated p-values.

Results : There were forty-one study participants, of which twenty-six disclosed their insurance status yielding a total of twenty unique zip codes. Seven of these zip codes were identified as being within the top sixteen zip codes with the highest poverty rate in SA. Conducting paired sample t-tests, we observed a significant increase in post-test results for insured patients (n=21, g=2.35, p <0.0005) and non-insured patients (n=5, g=2.18, p=0.0131). Further narrowing the analysis to participants in the top sixteen highest poverty zip codes in SA, we found a significant increase in post-test results (n=8, g=2.91, p=0.0001).

Conclusions : Our findings indicate that the insured group exhibited the highest improvement in retaining ocular health lessons, although all groups demonstrated a substantial enhancement in post-survey data retention of health lessons. These findings support the need for heightened health literacy initiatives in SA, particularly in regions significantly influenced by social determinants of health.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Figure 1. 5-digit zip codes among respondents.