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Do We Deliver to High-Risk People Who Can Benefit Most From It?

Xinzhi Zhang, MD, PhD; Jinan B. Saaddine, MD, MPH; Paul P. Lee, MD, JD; David C. Grabowski, PhD; Sanjat Kanjilal, MPH; Michael R. Duenas, OD; K. M. Venkat Narayan, MD, MSc

Arch Ophthalmol. 2007;125(3):411-418.

Objective  To estimate the levels of self-reported access of eye care services in the nation.

Methods  We analyzed data from the 2002 National Health Interview Survey (30 920 adults aged 18 years). We estimated the number of US adults at high risk for serious vision loss and assessed factors associated with the use of eye care services.

Results  An estimated 61 million adults in the United States were at high risk for serious vision loss (they had diabetes, had vision or eye problems, or were aged 65 years); 42.0% of the 78 million adults who had dilated eye examinations in the past 12 months were among this group. Among the high-risk population, the probability of having a dilated eye examination increased with age, education, and income (P<.01). The probability of receiving an examination was higher for the insured, women, persons with diabetes, and those with vision or eye problems (P<.01). Approximately 5 million high-risk adults could not afford eyeglasses when needed; being female, having low income, not having insurance, and having vision or eye problems were each associated with such inability (P<.01).

Conclusions  There is substantial inequity in access to eye care in the United States. Better targeting of resources and efforts toward people at high risk may help reduce these disparities.

Author Affiliations: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Zhang, Saaddine, Duenas, and Narayan and Mr Kanjilal); Department of Ophthalmology, Duke University Medical Center, Durham, NC (Dr Lee); and Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Grabowski). Dr Narayan is now with the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta.

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