title: The impact of lack of government-insured routine eye examinations on the incidence of self-reported glaucoma, cataracts, and vision loss.
abstract: OBJECTIVE
  We determined the impact of lack of government insured routine eye examinations on the incidence of self-reported glaucoma, cataracts and vision loss.
  
  
  METHODS
  We analyzed data from the Canadian longitudinal National Population Health Survey (1994-2011). White respondents aged 65+ in 1994/1995 were included (n = 2618). Three cohorts were established at baseline: those free of glaucoma, cataracts, and vision loss (i.e., unable to see close or distance when wearing glasses or contact lenses). Incident cases were identified through self-reporting of these conditions during the follow-up period.
  
  
  RESULTS
  The incidence (per 1000 person-years) of glaucoma was lower in uninsured provinces (8.1; 95% confidence interval [CI], 5.5-10.7) than in insured provinces (12.8; 95% CI, 10.5-15.1). The incidence of cataracts was also lower in the uninsured (67.2; 95% CI, 55.7-78.6) versus insured provinces (75.7; 95% CI, 69.2-82.2). The incidence of vision loss was higher in the uninsured (26.6; 95% CI, 20.2-33.0) versus insured provinces (22.5; 95% CI, 20.0-25.5). Adjusting for confounders, seniors in insured provinces had a 59% increased risk of glaucoma (incidence rate ratio [IRR], 1.59; 95% CI, 1.07-2.37), a 13% greater risk of cataracts (IRR, 1.13; 95% CI, 0.93-1.37), and a 12% reduced risk of vision loss (IRR, 0.88; 95% CI, 0.67-1.16).
  
  
  CONCLUSIONS
  Lack of government-funded routine eye examinations is associated with a reduced incidence of self-reported glaucoma and cataracts, likely due to reduced detection. Lack of insurance also is associated with a higher incidence of self-reported vision loss, likely due to poorer access to eye care and late treatment.
authors.affiliation: Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Christina H
authors.initials: CH
authors.lastname: Chan
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Graham E
authors.initials: GE
authors.lastname: Trope
authors.affiliation: Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Badley
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Buys
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Jin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000453:epidemiology*; D002170:Canada / Q000453:epidemiology; D002386:Cataract / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005901:Glaucoma / Q000453:epidemiology*; D006078:Government Programs; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D009313:National Health Programs; D012044:Regression Analysis; D012923:Social Class; D015351:Vision Screening
keywords: cataracts; glaucoma; government insurance; incidence; vision loss