title: Vision health disparities in the United States by race/ethnicity, education, and economic status: findings from two nationally representative surveys.
abstract: OBJECTIVE
  To assess vision health disparities in the United States by race/ethnicity, education, and economic status.
  
  
  METHODS
  Cross-sectional, nationally representative samples.
  
  
  METHODS
  We used national survey data from the National Health and Nutrition Examination Survey (NHANES) and the National Health Interview Survey (NHIS). Main outcome measures included, from NHANES, age-related eye diseases (ie, age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], glaucoma) and from NHIS, eye care use (ie, eye doctor visits and cannot afford eyeglasses when needed) among those with self-reported visual impairment. The estimates were age- and sex-standardized to the 2000 US Census population. Linear trends in the estimates were assessed by weighted least squares regression.
  
  
  RESULTS
  Non-Hispanic whites had a higher prevalence of AMD and cataract surgery than non-Hispanic blacks, but a lower prevalence of DR and glaucoma (all P < .001 in NHANES 2005-2008). From 1999 to 2008, individuals with less education (ie, <high school vs >high school) and lower income (poverty income ratio [PIR] <1.00 vs ≥ 4.00) were consistently less likely to have had an eye care visit in the past 12 months compared with their counterparts (all P < .05). During this period, inability to afford needed eyeglasses increased among non-Hispanic whites and Hispanics (trend P = .004 and P = .007; respectively), those with high school education (trend P = .036), and those with PIR 1.00-1.99 (trend P < .001).
  
  
  CONCLUSIONS
  Observed vision health disparities suggest a need for educational and innovative interventions among socioeconomically disadvantaged groups.
authors.affiliation: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3727, USA. XZhang4@cdc.gov
authors.forename: Xinzhi
authors.initials: X
authors.lastname: Zhang
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: Cotch
authors.forename: Asel
authors.initials: A
authors.lastname: Ryskulova
authors.forename: Susan A
authors.initials: SA
authors.lastname: Primo
authors.forename: Parvathy
authors.initials: P
authors.lastname: Nair
authors.forename: Chiu-Fang
authors.initials: CF
authors.lastname: Chou
authors.forename: Linda S
authors.initials: LS
authors.lastname: Geiss
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Barker
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Elliott
authors.forename: John E
authors.initials: JE
authors.lastname: Crews
authors.forename: Jinan B
authors.initials: JB
authors.lastname: Saaddine
mesh_terms: D000328:Adult; D002386:Cataract / Q000208:ethnology; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003930:Diabetic Retinopathy / Q000208:ethnology; D004522:Educational Status; D005006:Ethnicity; D005128:Eye Diseases / Q000208:ethnology*; D005901:Glaucoma / Q000208:ethnology; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D008268:Macular Degeneration / Q000208:ethnology; D009749:Nutrition Surveys; D044469:Racial Groups; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology