title: Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997-2012.
abstract: OBJECTIVE
  To study trends of barriers to receiving recommended eye care among subjects with diabetes aged 20-81 years in northeast Germany.
  
  
  RESULTS
  We analyzed population-based data from two repeated cross-sectional surveys conducted in 1997-2001 and 2008-2012 (Ns of 4308 and 4402). Andersen's Behavioral Model of Health Services Utilization was used to identify individual-level demographic, financial and health-related barriers to annual eye-care utilization in subjects with a self-reported physician's diabetes and to examine population trends in these barriers. The prevalence of diabetes increased from 6.5% to 11.4%. The prevalence of annual eye-care utilization among persons with diabetes decreased from 69.4% to 56.0% (adjusted relative risk = 0.77, p < 0.001). The decline of eye care utilization over the past decade in eye-care use was more pronounced in groups at risk for diabetes-related complications (i.e., lower socio-economic status, >5 years since diagnosis of diabetes, poor glycemic control, obesity, smoking, lack of physical activity, co-existing diseases). We identified relevant predictors of missed annual eye-care use among diabetics.
  
  
  CONCLUSIONS
  The increase of diabetes prevalence and downward trend of eye-care visits at the recommended level call for development, implementation and evaluation of continued efforts to improve access to eye specialists, particularly among those with poor diabetic control, co-existing diabetic complications, and comorbidities.
authors: Institute of Epidemiology and Preventive Medicine, University of Regensburg, Germany; Institute for Community Medicine, University Medicine Greifswald, Germany. Electronic address: sebastian.baumeister@ukr.de.
authors: S E
authors: SE
authors: Baumeister
authors: Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Germany; Helios Hanseklinikum, Stralsund, Germany.
authors: G
authors: G
authors: Schomerus
authors: Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, USA.
authors: R M
authors: RM
authors: Andersen
authors: Department of Ophthalmology, University Medicine Greifswald, Germany.
authors: F
authors: F
authors: Tost
authors: Institute for Community Medicine, University Medicine Greifswald, Germany; Department of Internal Medicine B, University Medicine Greifswald, Germany.
authors: M R P
authors: MR
authors: Markus
authors: Institute for Community Medicine, University Medicine Greifswald, Germany.
authors: H
authors: H
authors: Völzke
authors: Institute for Community Medicine, University Medicine Greifswald, Germany.
authors: C
authors: C
authors: Jürgens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D003941:Diagnostic Techniques, Ophthalmological; D005128:Eye Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000706:statistics & numerical data / Q000639:trends
keywords: Diabetes; Diabetic retinopathy; Eye care; Ocular disease; Trends