title: Factors Associated With Ocular Health Care Utilization Among Hispanics/Latinos: Results From an Ancillary Study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
abstract: OBJECTIVE
  Regular ocular care is critical to early detection and prevention of eye disease and associated morbidity and mortality; however, there have been relatively few studies of ocular health care utilization among Hispanics/Latinos of diverse backgrounds.
  
  
  OBJECTIVE
  To examine factors associated with ocular health care utilization among Cuban, Central American, and South American Hispanics/Latinos in a cohort study.
  
  
  METHODS
  An ancillary study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) evaluating ocular health, knowledge, risk factors, and health care use was conducted with 1235 HCHS/SOL participants (aged ≥40 years) at the Miami, Florida, study site. Data were collected from October 17, 2011, to September 30, 2013, and analyses were conducted from May 28, 2014, to March 18, 2015. Descriptive and multivariable logistic regression analyses were performed for 3 ocular health care outcomes. Regression models were built sequentially with variables conceptually grouped according to Andersen's Behavioral Model of Health Services Use.
  
  
  METHODS
  Ever having an eye examination, having an eye examination performed within the past 2 years, and difficulty obtaining needed eye care in the past year.
  
  
  RESULTS
  Of the 1235 participants, 478 were men and 757 were women, and they had a mean (SD) age of 53.6 (8.1) years. Those who never had insurance were less likely to have had an eye examination (with data reported as odds ratios [95% CIs]) ever, 0.19 (0.07-0.53) and in the past 2 years, 0.22 (0.15-0.33) and were more likely to have had difficulty obtaining needed eye care in the past year (3.72 [1.75-7.93]). Those with less than excellent or good self-rated eyesight were less likely to ever have had an eye examination (0.26 [0.12-0.56]) and more likely to have had difficulty obtaining care (3.00 [1.48-6.11]). Men were less likely to ever have had an eye examination (0.31 [0.18-0.53]). Older (55-64 years) Hispanics/Latinos (3.04 [1.47-6.31]) and those with a high school degree or general educational development certification (2.06 [1.02-4.13]) or higher levels of education (4.20 [2.12-8.30]) were more likely to ever have had an eye examination. Finally, those living in the United States for more than 15 years (0.42 [0.21-0.82]) were less likely to have had difficulty obtaining care.
  
  
  CONCLUSIONS
  Our findings suggest that increasing insurance coverage, decreasing the costs of care, and increasing the availability of care for Hispanics/Latinos with poor self-rated eyesight are relevant issues to address to improve ocular health care use among Hispanics/Latinos of diverse backgrounds.
authors.affiliation: Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Laura A
authors.initials: LA
authors.lastname: McClure
authors.affiliation: Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: D Diane
authors.initials: DD
authors.lastname: Zheng
authors.affiliation: Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Byron L
authors.initials: BL
authors.lastname: Lam
authors.affiliation: Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Tannenbaum
authors.affiliation: Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Joslin
authors.affiliation: Department of Biostatistics-Collaborative Studies Coordinating Center, Gillings School of Public Health, University of North Carolina at Chapel Hill.
authors.forename: Sonia
authors.initials: S
authors.lastname: Davis
authors.affiliation: Center for Latino/a Studies and Engagement, Oregon State University, Corvallis7School of Public Health, Universidad San Francisco de Quito, Quito, Ecuador.
authors.forename: Daniel
authors.initials: D
authors.lastname: López-Cevallos
authors.affiliation: Department of Biostatistics-Collaborative Studies Coordinating Center, Gillings School of Public Health, University of North Carolina at Chapel Hill.
authors.forename: Marston E
authors.initials: ME
authors.lastname: Youngblood
authors.affiliation: Epidemiological Cardiology Research Center, Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina.
authors.forename: Zhu-Ming
authors.initials: ZM
authors.lastname: Zhang
authors.affiliation: Department of Psychology, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Claudia Pulido
authors.initials: CP
authors.lastname: Chambers
authors.affiliation: Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D002489:Central America / Q000208:ethnology; D015331:Cohort Studies; D003462:Cuba / Q000208:ethnology; D005128:Eye Diseases / Q000208:ethnology*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research; D006306:Health Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D012307:Risk Factors; D013020:South America / Q000208:ethnology; D014787:Vision Tests
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