Association of Socioeconomic, Demographic, and Health Care Access Disparities With Severe Visual Impairment in the US
Association of Socioeconomic, Demographic, and Health Care Access Disparities With Severe Visual Impairment in the US
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DOI：
10.1001/jamaophthalmol.2022.4566
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发表时间：
2022-11-03
影响因子：
8.1
通讯作者：
Patel, Shriji
中科院分区：
文献类型：
--
作者：
Besagar, Sonya;Yonekawa, Yoshihiro;Patel, Shriji
大约13%的美国成年人受到视力障碍的影响，在受某些健康社会决定因素（SDOH）影响的群体中，这一比例更高。目的评价重度视力损害（SVI）相关的SDOH，最终指导有针对性的干预措施，改善眼健康。设计、环境和参与者本质量改进研究使用了2019年1月至2020年12月在美国进行的行为风险因素监测系统（BRFSS）电话调查的横断面数据。参与者是随机选择和采访的非机构成年平民，并自我认定为“失明或视力严重困难，即使戴着眼镜”。人口和获得保健的因素。主要结局和测量主要结局是SVI风险与各种因素相关，以比值比（or）和95% ci衡量。在BRFFS中使用web启用分析工具进行描述性和逻辑回归分析。结果在研究期间，共有820 226人（53.07%为女性）参加了BRFSS调查，其中42 412人（5.17%）自认为“失明或即使戴眼镜也有严重视力困难”。与白人、非西班牙裔个体相比，美洲印第安人/阿拉斯加原住民（OR, 1.63; 95% CI, 1.38-1.91）、黑人/非裔美国人（OR, 1.50; 95% CI, 1.39-1.62）、西班牙裔（OR, 1.65; 95% CI, 1.53-1.79）和多种族个体（OR, 1.33; 95% CI, 1.15-1.53）发生SVI的风险增加。较低的家庭年收入和教育水平（如未完成高中学业）与SVI风险较高相关。失业一年或更长时间的个体（or, 1.78; 95% CI, 1.54-2.07）或报告无法工作的个体（or, 2.90; 95% CI, 2.66-3.16）与研究的其他变量相比，SVI的几率更高。精神健康诊断和每月有14天或更长时间精神健康状况不佳与SVI风险增加相关（or, 1.87; 95% CI, 1.73-2.02）。与视力损害风险增加相关的卫生保健获取因素包括缺乏卫生保健覆盖范围和无法负担看医生的费用。在本研究中，各种SDOH与SVI相关，包括自我认同为来自种族或少数民族群体；社会经济地位和教育水平低；长期失业和丧失工作能力；离婚、分居或丧偶的婚姻状况；精神健康状况不佳；缺乏医疗保险。这些护理方面的差异和获得保健服务的障碍应指导有针对性的干预措施。
IMPORTANCE Approximately 13% of US adults are affected by visual disability, with disproportionately higher rates in groups impacted by certain social determinants of health (SDOH).OBJECTIVE To evaluate SDOH associated with severe visual impairment (SVI) to ultimately guide targeted interventions to improve ophthalmic health.DESIGN, SETTING, AND PARTICIPANTS This quality improvement study used cross-sectional data from a telephone survey from the Behavioral Risk Factor Surveillance System (BRFSS) that was conducted in the US from January 2019 to December 2020. Participants were noninstitutionalized adult civilians who were randomly selected and interviewed and self-identified as "blind or having serious difficulty seeing, even while wearing glasses."EXPOSURES Demographic and health care access factors.MAIN OUTCOMES AND MEASURES The main outcomewas risk of SVI associated with various factors as measured by odds ratios (ORs) and 95% CIs. Descriptive and logistic regression analyses were performed using theWeb Enabled Analysis Tool in the BRFFS.RESULTS During the study period, 820 226 people (53.07% female) participated in the BRFSS survey, of whom 42 412 (5.17%) self-identified as "blind or having serious difficulty seeing, even while wearing glasses." Compared with White, non-Hispanic individuals, risk of SVI was increased among American Indian/Alaska Native (OR, 1.63; 95% CI, 1.38-1.91), Black/African American (OR, 1.50; 95% CI, 1.39-1.62), Hispanic (OR, 1.65; 95% CI, 1.53-1.79), and multiracial (OR, 1.33; 95% CI, 1.15-1.53) individuals. Lower annual household income and educational level (eg, not completing high school) were associated with greater risk of SVI. Individuals who were out of work for 1 year or longer (OR, 1.78; 95% CI, 1.54-2.07) or who reported being unable to work (OR, 2.90; 95% CI, 2.66-3.16) had higher odds of SVI compared with the other variables studied. Mental health diagnoses and 14 or more days per month with poor mental health were associated with increased risk of SVI (OR, 1.87; 95% CI, 1.73-2.02). Health care access factors associated with increased visual impairment risk included lack of health care coverage and inability to afford to see a physician.CONCLUSIONS AND RELEVANCE In this study, various SDOH were associated with SVI, including self-identification as being from a racial or ethnic minority group; low socioeconomic status and educational level; long-term unemployment and inability to work; divorced, separated, or widowed marital status; poor mental health; and lack of health care coverage. These disparities in care and barriers to health care access should guide targeted interventions.