title: Disparities in visual impairment by immigrant status in the United States.
abstract: OBJECTIVE
  To examine differences in visual impairment between immigrants and natives in the United States (US).
  
  
  METHODS
  This is a cross-sectional study of clinical vision examination data from the 2003-2008 National Health and Nutrition Examination Survey.
  
  
  METHODS
  Analyses compare myopia, hyperopia, astigmatism, and visual acuity between noncitizens, naturalized citizens, and US natives. Visual acuity variables included having 20/40 or better corrected vision. Differences in 20/20 vision and legal blindness (20/200 or worse) were also examined. Respondents born in the United States were defined as US natives. Foreign-born respondents were categorized as either naturalized US citizens or noncitizen residents. Multivariate logistic regression of outcomes adjusted for sex, age, race/ethnicity, poverty, insurance, diabetes, and surgical correction for eyesight.
  
  
  RESULTS
  A smaller percentage of noncitizens than US natives had myopia (18.8% vs 30.7%) or astigmatism (22.0% vs 30.9%). However, noncitizens using corrective lenses had an adjusted odds ratio (AOR) of 0.65 of having 20/20 vision compared to US natives (95% confidence interval [CI] 0.48-0.88). Differences in visual acuity for 20/40 and better vision were not statistically significant for corrective lens users. Among nonusers of corrective lenses, noncitizens were significantly less likely than US natives to have 20/40 or better vision (AOR = 0.54; 95% CI 0.39-0.74). Noncitizens also had up to 3.5 times the odds of being legally blind relative to US natives after adjusting for confounding factors (95% CI 1.52-7.83).
  
  
  CONCLUSIONS
  Significant differences in visual acuity exist between immigrants and US natives. More research is necessary to identify underlying factors that may explain these disparities in visual impairment.
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska. Electronic address: fernando.wilson@unmc.edu.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Wilson
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Jim P
authors.initials: JP
authors.lastname: Stimpson
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Asia Sikora
authors.initials: AS
authors.lastname: Kessler
authors.affiliation: Stanley Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Diana V
authors.initials: DV
authors.lastname: Do
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Denise H
authors.initials: DH
authors.lastname: Britigan
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001251:Astigmatism / Q000453:epidemiology*; D002648:Child; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000453:epidemiology*; D009749:Nutrition Surveys; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D014792:Visual Acuity / Q000502:physiology; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*; D055815:Young Adult