title: Do Immigrants Underutilize Optometry Services?
abstract: OBJECTIVE
  To characterize utilization of office-based optometry services by immigration status using a nationally representative database.
  
  
  METHODS
  The 2007 to 2011 Medical Expenditure Panel Survey is used to examine adults aged 18 years and older. Respondents were classified as US natives, naturalized citizens, and noncitizens. Multivariate logistic regression analysis examined the relationship of having visited an office-based optometrist within the past 12 months by immigrant status, adjusting for age, sex, education, race/ethnicity, marital status, self-reported vision difficulty, use of corrective lenses, poverty status, insurance, language barrier and usual source of care. Oaxaca-Blinder decomposition identified factors that perpetuate or ameliorate disparities in utilization across immigrant groups.
  
  
  RESULTS
  The proportion of US natives who had visited an optometrist within the past year was 7.2%, almost three times higher than that for noncitizens (2.5%). Among respondents who reported vision difficulties, only 47.9% of noncitizens used corrective lenses compared with 71.0% of naturalized citizens and 71.6% of US natives. Adjusting for confounding factors, multivariate logistic regression showed that naturalized citizens and noncitizen residents had significantly lower odds than US natives of receiving optometry services (naturalized citizen adjusted odds ratio, 0.77; 95% confidence interval, 0.66 to 0.89; noncitizen adjusted odds ratio, 0.44; 95% confidence interval, 0.36 to 0.53). Decomposition analysis suggested that 17% of the disparity in utilization between noncitizens and US natives resulted from barriers to care such as language barriers, poverty, lack of insurance, and not having a usual source of health care.
  
  
  CONCLUSIONS
  Prior literature suggests that immigrants have significantly poorer clinical vision outcomes than US natives. Our findings suggest that this disparity in clinical vision outcomes may result from underutilization of optometry services by immigrants compared with US natives. Immigrant patients may need targeted interventions that reduce barriers to care and change their perceptions so that regular eye care services are viewed as necessary and preventative.
authors.affiliation: *PhD †MA College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska (FAW, YW). School of Public Health, City University of New York, New York (JPS).
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Wilson
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.forename: Jim P
authors.initials: JP
authors.lastname: Stimpson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006296:Health Services / 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; D016017:Odds Ratio; D009907:Optometry / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty; D055815:Young Adult