title: Barriers to eye care among people aged 40 years and older with diagnosed diabetes, 2006-2010.
abstract: OBJECTIVE We examine barriers to receiving recommended eye care among people aged ≥40 years with diagnosed diabetes. RESEARCH DESIGN AND METHODS We analyzed 2006-2010 Behavioral Risk Factor Surveillance System data from 22 states (n = 27,699). Respondents who had not sought eye care in the preceding 12 months were asked the main reason why. We categorized the reasons as cost/lack of insurance, no need, no eye doctor/travel/appointment, and other (meaning everything else). We used multinomial logistic regression to control for race/ethnicity, education, income, and other selected covariates. RESULTS Among adults with diagnosed diabetes, nonadherence to the recommended annual eye examinations was 23.5%. The most commonly reported reasons for not receiving eye care in the preceding 12 months were "no need" and "cost or lack of insurance" (39.7 and 32.3%, respectively). Other reasons were "no eye doctor," "no transportation" or "could not get appointment" (6.4%), and "other" (21.5%). After controlling for covariates, adults aged 40-64 years were more likely than those aged ≥65 years (relative risk ratio [RRR] = 2.79; 95% CI 2.01-3.89) and women were more likely than men (RRR = 2.33; 95% CI 1.75-3.14) to report "cost or lack of insurance" as their main reason. However, people aged 40-64 years were less likely than those aged ≥65 years to report "no need" (RRR = 0.51; 95% CI 0.39-0.67) as their main reason. CONCLUSIONS Addressing concerns about "cost or lack of insurance" for adults under 65 years and "no perceived need" among those 65 years and older could help improve eye care service utilization among people with diabetes.
authors.affiliation: Corresponding author: Chiu-Fang Chou, cchou@cdc.gov.
authors.forename: Chiu-Fang
authors.initials: CF
authors.lastname: Chou
authors.forename: Cheryl E
authors.initials: CE
authors.lastname: Sherrod
authors.forename: Xinzhi
authors.initials: X
authors.lastname: Zhang
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Barker
authors.forename: Kai McKeever
authors.initials: KM
authors.lastname: Bullard
authors.forename: John E
authors.initials: JE
authors.lastname: Crews
authors.forename: Jinan B
authors.initials: JB
authors.lastname: Saaddine
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D040343:Behavioral Risk Factor Surveillance System; D048909:Diabetes Complications / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010808:Physical Examination / Q000191:economics / Q000706:statistics & numerical data; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014481:United States