Eye Care Availability and Access Among Individuals With Diabetes, Diabetic Retinopathy, or Age-Related Macular Degeneration
Eye Care Availability and Access Among Individuals With Diabetes, Diabetic Retinopathy, or Age-Related Macular Degeneration
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DOI：
10.1001/jamaophthalmol.2013.7682
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发表时间：
2014-04-01
影响因子：
8.1
通讯作者：
Gibson, Diane M.
中科院分区：
文献类型：
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作者：
Gibson, Diane M.
重要性了解当地眼科护理专业人员的可用性差异是否与实现获得眼科护理的差异有关，对于评估是否以及在何处需要公共卫生努力来增加获得眼科护理专业人员的机会非常重要。糖尿病视网膜病变或年龄相关性黄斑变性（ARMD）。设计、地点和参与者我们研究了一个40岁及以上美国成年人的横断面样本（1098名糖尿病患者，345名糖尿病视网膜病变患者，和498与ARMD）从2005年-2008年全国健康和营养检查调查。主要结果和测量结果是糖尿病患者是否报告过去接受过散瞳眼科检查。结果在还包括个体特征的逻辑回归模型中，居住在眼科医生可用性最高的四分位数的县的个体不太可能不知道他们患有糖尿病视网膜病变（预测边界[ PM]，66.1%; 90% CI，. 48.8%-83.4%; vs PM，84.1%; 90%CI，78.7%-89.6%），并且与居住在眼科医生可用性较低的县的个人相比，患有危及视力的糖尿病视网膜病变的可能性较小（PM，1.4%; 90%CI，0.9%-1.9%; vs PM，2.6%; 90%CI，1.8%-3.4%）。居住在眼科医生可用性最低四分位数的县的个人比居住在眼科医生可用性最高三个四分位数的县的个人更有可能不知道他们患有ARMD（PM，93.8%; 90% CI，90.6%-97.0%; vs PM，88.3%; 90% CI，84.7%-91.9%）。验光师可用性四分位数与任何outcomes.Conclusions和相关性结果表明，努力增加获得眼科医生，以改善与糖尿病视网膜病变相关的结果或提高对ARMD的认识，应重点改善居住在眼科医生可用性最低的3个四分位数的县的糖尿病患者的获得，以及居住在眼科医生可用性最低的3个四分位数的县的ARMD风险的个人。眼科医生可用性的最低四分位数。
IMPORTANCE Understanding whether differences in the local availability of eye care professionals are related to differences in realized access to eye care is important for assessing whether and where public health efforts are needed to increase access to eye care professionals.OBJECTIVE To examine whether the county-level availability of ophthalmologists and optometrists is associated with measures of realized access to eye care for individuals with diabetes mellitus, diabetic retinopathy, or age-related macular degeneration (ARMD).DESIGN, SETTING, AND PARTICIPANTS We studied a cross-sectional sample of US adults 40 years and older (1098 individuals with diabetes, 345 with diabetic retinopathy, and 498 with ARMD) from the 2005-2008 National Health and Nutrition Examination Survey.MAIN OUTCOMES AND MEASURES Outcomes were whether diabetic individuals reported undergoing a dilated eye examination in the past year, whether individuals were unaware they had diabetic retinopathy, whether diabetic individuals had vision-threatening diabetic retinopathy, and whether individuals were unaware they had ARMD.RESULTS In logistic regression models that also included individual characteristics, individuals who lived in a county in the highest ophthalmologist availability quartile were less likely to be unaware they had diabetic retinopathy (predictive margin [ PM], 66.1%; 90% CI,. 48.8%-83.4%; vs PM, 84.1%; 90% CI, 78.7%-89.6%) and were less likely to have vision-threatening diabetic retinopathy (PM, 1.4%; 90% CI, 0.9%-1.9%; vs PM, 2.6%; 90% CI, 1.8%-3.4%) than individuals who lived in a county in the lower 3 ophthalmologist availability quartiles. Individuals who lived in a county in the lowest ophthalmologist availability quartile were more likely to be unaware they had ARMD (PM, 93.8%; 90% CI, 90.6%-97.0%; vs PM, 88.3%; 90% CI, 84.7%-91.9%) than individuals who lived a county in the higher 3 ophthalmologist availability quartiles. Optometrist availability quartiles were not significantly related to any of the outcomes.CONCLUSIONS AND RELEVANCE The results suggest that efforts to increase access to ophthalmologists to improve outcomes related to diabetic retinopathy or to increase awareness of ARMD should focus on improving access for diabetic individuals who live in counties in the lowest 3 quartiles of ophthalmologist availability and on individuals at risk of ARMD who live in counties in the lowest quartile of ophthalmologist availability.