title: Racial disparities in uncorrected and undercorrected refractive error in the United States.
abstract: OBJECTIVE
  To identify risk factors for inadequately corrected refractive error in the United States.
  
  
  METHODS
  This cross-sectional study included 12,758 participants 12 years of age and older from the 2005 to 2008 National Health and Nutrition Examination Survey. The primary outcome was the proportion of individuals with inadequate refractive correction for whom refractive correction would result in a visual acuity of 20/40 or better. The primary predictor was race/ethnicity. Secondary predictors included age, sex, annual household income, education, insurance, type of refractive error, current corrective lens use, presenting and best corrected visual acuity, cataract surgery, glaucoma, and age-related macular degeneration.
  
  
  RESULTS
  Overall, 50.6% of subjects had a refractive error which was correctable to 20/40 or better with refraction. The percentage of subjects with correctable refractive error who were inadequately corrected was 11.7%. Odds of inadequate refractive correction were significantly greater in Mexican Americans and non-Hispanic blacks than in their non-Hispanic white counterparts in all age groups, with the greatest disparity in the 12- to 19-year-old group. Other risk factors associated with inadequate refractive correction in adults but not in teenagers included low annual household income, low education, and lack of health insurance.
  
  
  CONCLUSIONS
  Racial disparities in refractive error correction were most pronounced in those under 20 years of age, as well as in adults with low annual household income, low education level, and lack of health insurance. Targeted efforts to provide culturally appropriate education, accessible vision screening, appropriate refractive correction, and routine follow-up to these medically underserved groups should be pursued as a public health strategy.
authors.affiliation: Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States.
authors.forename: Mary
authors.initials: M
authors.lastname: Qiu
authors.affiliation: Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States.
authors.forename: Sophia Y
authors.initials: SY
authors.lastname: Wang
authors.affiliation: Department of Ophthalmology, Stanford University, Stanford, California, United States.
authors.forename: Kuldev
authors.initials: K
authors.lastname: Singh
authors.affiliation: Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States.
authors.forename: Shan C
authors.initials: SC
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D005139:Eyeglasses; D005260:Female; D006801:Humans; D008297:Male; D009749:Nutrition Surveys / Q000379:methods*; D015995:Prevalence; D044469:Racial Groups; D012029:Refraction, Ocular; D012030:Refractive Errors / Q000208:ethnology* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014792:Visual Acuity; D055815:Young Adult
keywords: NHANES; ethnic disparities; healthcare access; racial disparities; refractive error