title: Prevalence of visual impairment in relation to the number of ophthalmologists in a given area: a nationwide approach.
abstract: BACKGROUND
  Sociological and economic risk factors of visual impairment have never been described in France at a national level as the association between the number of ophthalmologists per inhabitant and visual impairment prevalence.
  
  
  METHODS
  Two national surveys were pooled. First, 2075 institutions were selected at random from the French Health Ministry files. Second, a random, stratified sample of 356,208 citizens living in the community was selected. Blindness and low vision (LV) prevalence rates were estimated by age and gender. Geographical equities were estimated by logistic regression adjusted on age and occupational category. The association between ophthalmologist density and visual impairment prevalence rate was estimated per region. Interviews were completed with 14,603 (94.9%) of 15,403 randomly selected subjects in institutions, and 16,945 (77.8%) of 21,760 randomly selected subjects in the community. Three groups were defined from the interviews: low vision, blind, and control.
  
  
  RESULTS
  Prevalence rates were LV 2.08% and blindness 0.12%. Both rates increased exponentially with age. No major difference was found with gender. Injury was the declared reason for both LV (12%) and blindness (12%). Large regional differences in prevalence persisted for LV after adjustment on age and occupation (ORs: 0.35 to 2.10), but not for blindness. Regions with ophthalmologists below the national per capita average were usually those with higher LV prevalence.
  
  
  CONCLUSIONS
  An inverse correlation was found between ophthalmologist number and LV prevalence rates for subjects of similar age and socio-professional category. This denoted possible inequity in the provision of healthcare.
authors.affiliation: antoine.lafuma@cemka.fr
authors.forename: Antoine J
authors.initials: AJ
authors.lastname: Lafuma
authors.forename: Antoine P
authors.initials: AP
authors.lastname: Brézin
authors.forename: Francis L
authors.initials: FL
authors.lastname: Fagnani
authors.forename: Mounir
authors.initials: M
authors.lastname: Mesbah
authors.forename: Gilles H
authors.initials: GH
authors.lastname: Berdeaux
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001766:Blindness / Q000453:epidemiology*; D017281:Cost of Illness; D004185:Disability Evaluation; D005260:Female; D005602:France / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology; D015995:Prevalence; D012650:Self Disclosure; D017062:Small-Area Analysis; D012959:Socioeconomic Factors; D015354:Vision, Low / Q000453:epidemiology*; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*; D000078329:Workforce