Disparities in Eye Care Utilization by Self-Reported Vision Difficulty and Diabetes Status in the United States

Purpose: To assess differences in eye care utilization by vision difficulty (VD), diabetes status, and sociodemographic characteristics for American adults. Methods: The analysis pooled cross-sectional data from the National Health Interview Survey (2010–2018) from US adults ≥ 18 years. The outcome measure was eye care utilization in the past year. The primary independent variable included four groups: no VD or diabetes, only diabetes, only VD, and diabetes and VD. VD was defined as self-reported difficulty seeing even with glasses or contacts. Diabetic status was defined as ever receiving this diagnosis by a health professional. Multivariable logistic regression analyses examined associations between eye care utilization, VD, diabetic status, and sociodemographic characteristics. Results: Of the 284,599 adults included in this study, the majority were female (55%), White (73%), and non-Hispanic (84%). In regression analysis, as compared to adults without diabetes or VD, adults with both diabetes and VD had the greatest utilization (OR = 2.49, 99% CI = 2.18–2.85). Females had higher utilization than men (OR = 1.45, 99% CI = 1.41–1.50). Higher levels of education was associated with greater utilization (OR = 1.82, 99% CI = 1.72–1.92). White and American Indian adults without diabetes had higher utilization compared to other races (OR = 1.17, 99% CI = 1.12–1.24, 0.98–1.39). Conclusion: While adults with VD and diabetes are better connected to eye care, significant eye care disparities persist for marginalized groups in the U.S. Identifying and understanding these disparities and eliminating barriers to care is critical to better support all patient populations.