Demographic and Socioeconomic Differences in Outpatient Ophthalmology Utilization in the United States

Rasendran, Chandruganesh; Tye, George; Knusel, Konrad; Singh, Rishi P.

doi:10.1016/j.ajo.2020.05.022

Cited by 38 publications

(42 citation statements)

References 24 publications

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“…However, both Hispanic and Black patients are less likely to use outpatient ophthalmology services than non-Hispanic White patients. 14 Therefore, ethnic/racial minorities may have been more likely to require new, rather J o u r n a l P r e -p r o o f than follow-up appointments during the pandemic, which are less able to be conducted in telemedicine settings. Telehealth underutilization among minorities may also be related to awareness and the advertising of such services.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] One recent study of a single-institution identified demographic differences in the rates of in-person visits for eyecare during the pandemic, 13 however there remains a paucity of literature about disparities in the uptake of telemedicine in ophthalmology, a field in which demographic differences in care utilization have been identified even prior to the COVID-19 pandemic. 14 As telehealth use in routine medical care continues to grow and COVID-19 continues to disproportionately impact minority patients, it is imperative to identify potential disparities in access to and use of virtual mediums in ophthalmic care. Therefore, the purpose our study was to J o u r n a l P r e -p r o o f examine the association between sociodemographic factors and the use of telemedicine in a large single-institution ophthalmology center during the peak of the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

“… 10 , 11 , 12 One recent study of a single-institution identified demographic differences in the rates of in-person visits for eyecare during the pandemic, 13 however there remains a paucity of literature about disparities in the uptake of telemedicine in ophthalmology, a field in which demographic differences in care utilization have been identified even prior to the COVID-19 pandemic. 14 …”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic and Demographic Disparities in the Use of Telemedicine for Ophthalmic Care during the COVID-19 Pandemic

2022

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Socioeconomic and Demographic Disparities in the Use of Telemedicine for Ophthalmic Care during the COVID-19 Pandemic

2022

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“…14 However, minorities and people of low socioeconomic status underutilize eye care, are disproportionately affected by barriers to care, and are at the greatest risk of vision loss. 6,7 It is widely accepted that an individual's health is determined primarily by factors outside of the healthcare system, such as poverty, unemployment, or lack of access to care. 15,16 In a previous study at our institution early in the COVID-19 pandemic, we found that individuals scheduled for recommended urgent eye appointments who did not adhere more often came from neighborhoods with a greater proportion of Blacks, greater unemployment rates, and a greater number of COVID-19 related deaths.…”

mentioning

confidence: 99%

“…14 However, minorities and people of low socioeconomic status underutilize eye care, are disproportionately affected by barriers to care, and are at the greatest risk of vision loss. 6, 7…”

mentioning

confidence: 99%

Evaluating the Relationship between Neighborhood-Level Social Vulnerability and Patient Adherence to Ophthalmology Appointments

Scanzera

Kravets

Hallak

et al. 2022

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Objective: Little is known about the association between neighborhood characteristics and non-adherence to attending scheduled ophthalmology appointments. The purpose of this study was to examine the association between neighborhood-level social vulnerability and adherence to scheduled ophthalmology appointments. Design: Retrospective cohort study. Participants: Adults aged 18 years and older with scheduled ophthalmology appointments between September 12, 2020, and February 8, 2021. Methods: A single-center study was conducted at the University of Illinois Chicago Illinois Eye and Ear Infirmary, an urban tertiary care referral center in Chicago, Illinois. Primary exposure is neighborhood-level Social Vulnerability Index (SVI), based on patient address of residence. The SVI ranks (possible range 0 to 1) each census tract on 15 social factors into four related themes (socioeconomic status, household composition & disability, minority status & language, and housing type & transportation). Higher SVI rankings indicate higher levels of social vulnerability. The overall SVI ranking and rankings for each of the four themes were analyzed separately as the primary exposure of interest in multivariable logistic regression models that controlled for age, sex, status (new or established appointment), race, and distance from clinic. Main Outcome Measure: Non-adherence to attending scheduled ophthalmology appointments, defined as missing more than 25% of scheduled appointments. Results: A total of 8,322 unique patients (41% non-Hispanic Black, 24% Hispanic, 22% non-Hispanic White) had scheduled appointments during the five-month study period (range 1 to 23 appointments). Of those, 28% of patients were non-adherent to appointments. In multivariable logistic regression models, non-adherence to appointments was associated with living in higher SVI ranking neighborhoods (socioeconomic status: (adjusted odds ratio [95% confidence interval]) 2.38 [1.94, 2.91]; household composition/disability: 1.51 [1.26, 1.81]; minority status/language: 2.03 [1.55, 2.68]; housing type/transportation: 1.41 [1.16, 1.73]; and overall SVI: 2.46 [1.99, 3.06]). Conclusions: Neighborhood-level measures of social vulnerability are associated with greater risk of non-adherence to scheduled ophthalmology appointments. Studies to better understand these neighborhood-level vulnerabilities are needed to inform the design and evaluation of multi-level (individual and neighborhood) strategies to reduce disparities in access to ophthalmology care.

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Inequities and Research Gaps in Ophthalmology

et al. 2023

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ImportanceDeficient ophthalmologic care is costly to patients, making the identification of groups not receiving adequate care of vital importance. The current landscape of equity in ophthalmic care has yet to be thoroughly investigated and is important to ensure inclusivity and patient-centered care.ObjectiveTo perform a scoping review of the literature pertaining to health care inequities in the field of ophthalmology.Evidence ReviewA comprehensive database search using MEDLINE (via PubMed) and Ovid Embase was done in July 2022. English-language articles published from 2016 to 2021 were included and encompassed all article types except commentaries or correspondence. The search modeled the National Institutes of Health list of designated US health inequity populations, which includes income, education level, occupational status, rural and underresourced area, sex and gender, lesbian, gay, bisexual, transgender, and queer (LGBTQ) identity, and race and ethnicity. A total of 8170 abstracts and titles were screened by 2 independent investigators, and 189 studies were assessed in full text for eligibility. For inclusion, articles needed to be an ophthalmic study discussing health inequities. In a masked, duplicate fashion, 2 independent investigators screened 75 full-text studies for data extraction using a pilot-tested form. Data extraction included general publication characteristics and health inequity data based on the National Institutes of Health’s defined inequity groups.FindingsA total of 75 publications were included. Notable inequities were found among Black and Hispanic patients associated with negative ophthalmic outcomes and mixed associations regarding sex or gender. Overall, lower-income patients were more likely to have vision impairment, use eye care services less, and have lower adherence to eye examinations. No articles within our sample examined LGBTQ inequities among ophthalmology patients since the 2016 National Institutes of Health classification of sexual and gender minority populations. Substantial research gaps were observed within the ophthalmic literature pertaining to the LGBTQ community, race and ethnicity, and rural and underresourced areas.Conclusions and RelevanceThis scoping review found substantial findings associated with the LGBTQ community, race and ethnicity, and the role of telemedicine in rural and underresourced areas. Because of the importance of ophthalmic care in overall patient health, it is vital to understand the various inequities present and strive to improve the current gaps in the literature. Future studies should (1) examine barriers to clinical study and medical trainee recruitment as well as patient values and preference studies and (2) investigate the implementation of telemedicine in underresourced areas.

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Demographic and Socioeconomic Differences in Outpatient Ophthalmology Utilization in the United States

Cited by 38 publications

References 24 publications

Socioeconomic and Demographic Disparities in the Use of Telemedicine for Ophthalmic Care during the COVID-19 Pandemic

Socioeconomic and Demographic Disparities in the Use of Telemedicine for Ophthalmic Care during the COVID-19 Pandemic

Evaluating the Relationship between Neighborhood-Level Social Vulnerability and Patient Adherence to Ophthalmology Appointments

Inequities and Research Gaps in Ophthalmology

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