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  • Racial Disparities Persist in Vision Care

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
    Comprehensive Ophthalmology
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    Journal Highlights

    Ophthalmology, July 2023

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    Inequities in the U.S. health system can undermine core American values. “It is essential for all domains of health care to identify relevant social determi­nants of health and to respond to the resulting health inequities accord-ingly,” said Chauhan et al., who ana­lyzed responses to the U.S. National Survey of Children’s Health (NSCH) to explore the demographics of visual impairment and unmet vision-care needs. As sug­gested by results of previous studies, they found that Black and Hispanic children fared poorly.

    The NSCH is a national, cross-sectional questionnaire that focuses on the physical and emotional health of children from birth to 17 years of age. For this study, 2016-2020 data were analyzed. The main outcome measures were vision impairment and unmet vision-care need. The prevalence of vision impairment was estimated from answers to the question “Does the child have blindness or problems with seeing, even when wearing glasses?” Respondents also were asked “During the past 12 months, was there any time when this child needed health care, but it was not received?,” which was followed by an inquiry into the type of care that was lacking. Income, a key indicator of socioeconomic status (SES), was factored into the study; based on the federal poverty level (FPL), income was classified as low SES (≤199% FPL) or high SES (≥400% FPL). Other demographic factors were sex, age group, and state of residence. Multivariable logistic regres­sion was performed, and the analyses were weighted to generate nationally representative estimates. Hot deck im- putation or sequential regression methods were applied when data on sex, income, or race/ethnicity were missing.

    Rates of vision impairment were highest in southern states, including Louisiana (2.35%), Alabama (2.25%), and Mississippi (2.15%). Among 6- to 11-year-olds, the prevalence of unmet needs and vision impairment was great­est for Hispanics (OR, 2.00 and 1.60 [respectively] vs. Whites). Among older children (12-17 years), Hispanics were more likely than Whites to be visually impaired (OR, 1.91), and non-Hispanic Blacks had the highest level of unmet need (OR, 2.45 vs. Whites). Geographi­cally, unmet needs were most pervasive in Georgia (1.05%), Wyoming (0.90%), and Texas (0.86%). In comparison to non-Hispanic Whites, non-Hispanic Blacks in the lowest SES (OR, 1.61) and highest SES (OR, 8.73) were sig­nificantly more likely to have unmet vision-related needs. Similarly, Hispan­ic children in these income categories were more likely than non-Hispanic Whites to be visually impaired (OR, 1.44 and 1.84, respectively). During the height of the Covid-19 pandemic, unmet needs climbed for all children but were most substantial for non- Hispanic Blacks and Hispanics, fol­lowed by non-Hispanic Asians.

    “The clustering of unmet vision care and impairment in southern states merits further investigation,” said the authors. They hope their findings will result in targeted actionable plans to improve vision for all children.

    The original article can be found here.