Trends in Eye Care Use and Eyeglasses Affordability: The US National Health Interview Survey, 2008-2016

Varshini Varadaraj, Kevin Frick, Jinan B. Saaddine, David S Friedman, Bonnielin Swenor

Research output: Contribution to journalArticle

Abstract

Importance: Understanding eye care use over time is essential to estimate continued unmet health care needs and help guide future public health priorities. Objective: To update trends in using eye care and affording eyeglasses in the United States. Design, Setting, and Participants: This analysis of data from the US National Health Interview Survey included adults 18 years and older from 9 annual cross-sectional population-based samples ranging in size from 21781 to 36697 participants from 2008 to 2016. Data were analyzed from August 2017 to February 2018. Exposures: Visual impairment, defined as self-reported difficulty seeing despite wearing eyeglasses. Main Outcomes and Measures: Outcome measures included visits to an eye care professional and inability to afford eyeglasses when needed in the past year. Survey logistic regression, adjusted for age, sex, race/ethnicity, visual impairment status, education, employment, general health, poverty-income ratio, and vision insurance, was used to examine associations between survey year and eye care outcomes. Results: Analyses included 9 annual cross-sectional population-based samples pooled from 2008 to 2016, ranging in size from 21781 to 36697 participants aged 18 years or older. Compared with 2008, greater proportions of the US population were 65 years or older, Hispanic, or Asian in 2016. There was a significant trend for eye care use and difficulty affording eyeglasses from 2008 to 2016. In fully adjusted models, Americans were less likely to use eye care in 2014 compared with 2008 (odds ratio [OR], 0.90; 99.9% CI, 0.82-0.98; P <.001). Compared with 2008, Americans were also less likely to report difficulty affording eyeglasses from 2014 onwards (2014: OR, 0.82; 99.9% CI, 0.69-0.97; P <.001; 2015: OR, 0.81; 99.9% CI, 0.69-0.96; P <.001; 2016: OR, 0.70; 99.9% CI, 0.59-0.82; P <.001). After adjusting for all covariates, including survey year, those with visual impairment compared with those without were more likely to use eye care (OR, 1.54; 99.9% CI, 1.45-1.65; P <.001) but had greater difficulty affording eyeglasses (OR, 3.86; 99.9% CI, 0.58-0.72; P <.001). Women were also more likely to use eye care (OR, 1.42; 99.9% CI, 1.37-1.48; P <.001) and report difficulty affording eyeglasses (OR, 1.68; 99.9% CI, 1.56-1.81; P <.001) compared with men. Compared with non-Hispanic white individuals, black, Asian, and Hispanic individuals were less likely to use eye care, and Asian and black individuals were less likely to have difficulty affording eyeglasses. Conclusions and Relevance: These data indicate decreased difficulty affording eyeglasses among Americans from 2014 to 2016, possibly related to economic recovery and health care reform. However, the findings suggest women and racial/ethnic minorities are more likely to have lower use of eye care or inability to afford eyeglasses.

Original languageEnglish (US)
JournalJAMA Ophthalmology
DOIs
StateAccepted/In press - Jan 1 2019

ASJC Scopus subject areas

  • Ophthalmology

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