Factors Associated with Annual Vision Screening in Diabetic Adults: Analysis of the 2019 National Health Interview Survey

Abstract

Purpose To determine the association(s) between receiving an annual eye exam and various economic, social, and geographic factors assessed in the 2019 National Health Interview Survey (NHIS) among adults with diabetes. Patients and Methods Data from adults 18 years of age and older relevant to self-reported non-gestational diabetes diagnosis and eye exam within the last 12 months were extracted from the 2019 NHIS dataset. A multivariate logistic regression model was used to determine associations between receiving an eye exam in the preceding 12 months and various economic, insurance-related, geographic, and social factors. Outcomes were reported as odds ratios (OR) with 95% confidence intervals (CI). Results Among diabetic adults in the US, receiving an eye exam within the last 12 months was significantly associated with female sex (OR 1.29; 95% CI 1.05–1.58), residence in the Midwestern United States (OR 1.39; 95% CI 1.01–1.92), use of Veteran’s Health Administration healthcare (OR 2.15; 95% CI 1.34–3.44), having a usual place to go for healthcare (OR 3.89; 95% CI 2.16–7.01), and the use of Private, Medicare Advantage, or other insurance (OR 3.66; 95% CI 2.42–5.53), use of Medicare only excluding Medicare Advantage (OR 3.18; 95% CI 1.95–5.30), dual eligibility for Medicare and Medicaid (OR 3.88; 95% CI 2.21–6.79), and use of Medicaid and other public health insurance (OR 3.04; 95% CI 1.89–4.88) compared to those without insurance. An educational attainment of less than high school (OR 0.66; 95% CI 0.48–0.92), and an educational attainment of high school or GED without any college (OR 0.62; 95% CI 0.47–0.81) reduced the odds of having an annual eye exam. Conclusion Economic, social, and geographic factors are associated with diabetic adults receiving an annual eye exam.

Social Determinants of Health and Perceived Barriers to Care in Diabetic Retinopathy Screening

“…Our findings regarding the association of socioeconomic factors with DR screening are consistent with prior studies . Low socioeconomic status was revealed to be associated with DR screening nonadherence, with studies showing that financial barriers or lack of health insurance were associated with not having an eye examination within 12 months for adults with diabetes .…”

“…Furthermore, our study showed that participants with food or housing instability had lower odds of having visited an eye care practitioner in the past year, reinforcing prior studies demonstrating that financial instability, such as food instability and housing instability, and paying bills were associated with not receiving eye care . Low educational level was also shown to be associated with nonadherence to DR screening recommendations in previous studies, likely due to limited health literacy . We also found that participants with a college or advanced degree were more likely to have visited an eye care practitioner in the past year.…”