Eye-Care Utilization Among Women Aged ≥40 Years with Eye Diseases --- 19 States, 2006--2008

Eye-Care Utilization Among Women Aged ≥40 Years with Eye Diseases --- 19 States, 2006--2008
Weekly
May 21, 2010 / 59(19);588-591


Diabetic retinopathy (DR), glaucoma, and age-related macular degeneration (ARMD) are major causes of vision loss and blindness (1). Women have been found to have a higher prevalence of vision loss than men (2,3). Early detection and timely treatment by eye-care providers are necessary to delay disease progression and prevent vision loss. To assess the use of professional eye care among women aged ≥40 years, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for 19 U.S. states for the period 2006--2008. This report summarizes the results of that analysis, which indicated that 21% of women with self-reported DR, 12% of women with self-reported glaucoma, and 8% of women with self-reported ARMD did not visit an eye-care provider in the recommended follow-up period. Women who did not have insurance coverage for eye care or who did not receive routine medical check-ups were more likely to report not having the recommended follow-up eye care. The two most commonly cited reasons for not having an eye-care visit were cost or not having insurance (range across diseases: 40%--46%) and having no reason to go for follow-up (range: 20%--29%). Compliance with obtaining eye examinations at recommended intervals among women aged ≥40 years with eye diseases might be enhanced by improving access to health care and implementing and expanding existing educational programs to raise awareness regarding the importance of routine follow-up eye examinations.

BRFSS is a state-based, random-digit--dialed telephone survey of the noninstitutionalized U.S. civilian population aged ≥18 years. With approximately 350,000 adults participating in the interview each year, BRFSS provides local, state, and national estimates of important information on sociodemographics, chronic illness, health behaviors, and access to health care. CDC analyzed data from the pooled respondents of 7,377 women aged ≥40 years with self-reported DR (322), glaucoma (356), or ARMD (244) by using results from the BRFSS Visual Impairment and Access to Eye Care Module for the period 2006--2008. Nineteen states* included the vision module in at least 1 year of their regular BRFSS survey during these years. Among the 19 states, the median Council of American Survey Research Organizations (CASRO) response rate (cooperation rate)† was 49.0% (73.5%) for 2006, 48.2% (69.0%) for 2007, and 52.8% (73.3%) for 2008. Respondents were classified as having an eye disease if they answered "yes" to any one of the relevant questions regarding presence of DR, glaucoma, and/or ARMD.§

For this study, the recommended follow-up period for visiting an eye-care provider was defined as the maximum recommended follow-up period stated in disease-specific guidelines in effect during the reporting period from the American Academy of Ophthalmology (for all three diseases), the American Optometric Association (for all three diseases), and the American Diabetes Association (for DR only). For DR and glaucoma, this period is within 12 months of the most recent eye examination; for ARMD, the period is within 24 months of the most recent eye examination. The BRFSS vision module also incorporated questions related to use of eye-care services. Women were classified as not having visited an eye-care professional in the recommended follow-up period if they answered other than "within the past month" or "within the past year" (for the 12-month period) or "within the past month," "within the past year," or "within the past 2 years (for the 24-month period) to the question, "When was the last time you had your eyes examined by any doctor or eye-care provider?" In addition, respondents were asked to select the one main reason they had not visited an eye-care professional in the previous year.¶

Statistical software was used to account for the complex sampling design. All analyses were weighted to make estimates representative of the age, race, and sex of the civilian, noninstitutionalized population in the 19 states. In instances where a state had more than 1 year of data available, average weights for the number of years available were used. CDC used predictive margin probabilities and corresponding 95% confidence intervals to make comparisons among the levels of each factor while adjusting for differences in the distributions of all other factors. The crude rate represents the weighted proportion of persons who did not report receiving recommended follow-up eye care. Adjusted percentages were estimated using logistic regression models predicting eye-care utilization as a function of the following factors: age, race/ethnicity, marital status, education, income, diabetes status, eye-care insurance coverage, and general health care (Table 1).

The weighted BRFSS data indicated that 21% of women with DR, 12% of women with glaucoma, and 8% of women with ARMD did not visit an eye-care provider in the recommended follow-up period (Table 1). Women without eye-care insurance were more likely than those with insurance to report not having obtained recommended eye-care visits for DR, glaucoma, and ARMD (predictive margin probabilities: 34% versus 14%, 18% versus 10%, and 12% versus 6%, respectively). Women who did not have a routine medical check-up in the preceding 12 months were more likely than those who did so to report not having made the recommended eye-care visits (36% versus 20%, 21% versus 12%, and 16% versus 7%, respectively). Additionally, women aged 40--64 years with glaucoma or ARMD were more likely to report not having obtained recommended eye care than those aged ≥65 years (25% versus 5% and 18% versus 4%, respectively). Cost and not having eye-care insurance (range: 40%--46% for the three eye diseases) and having no reason to go (range: 20%--29%) were the two most commonly cited reasons women with eye diseases reported for not having visited an eye-care provider (Table 2).

Reported by
AF Elliott, PhD, CF Chou, PhD, X Zhang, MD, PhD, JE Crews, DPA, JB Saaddine, MD, GL Beckles, MD, MD Owens-Gary, PhD, Div of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC.

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Eye-Care Utilization Among Women Aged ≥40 Years with Eye Diseases --- 19 States, 2006--2008