Barriers to eye care among people aged 40 years and older with diagnosed diabetes, 2006-2010

  1. Jinan Saaddine, MD, MPH
  1. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (Chou, Zhang, Barker, Bullard, Crews, Saaddine); Division of Data Management and Scientific Reporting, National Institute of Health, Bethesda, MD (Zhang); Bloomberg School of Public Health School of Public Health, Johns Hopkins University, Baltimore, MD (Sherrod).
  1. Corresponding author: Chiu-Fang Chou, E-mail: CChou{at}


Objective To examine barriers to receiving recommended eye care among people aged ≥40 years with diagnosed diabetes.

Method We analyzed 2006-2010 Behavioral Risk Factor Surveillance System data from 22 states (n=27,699). Respondents who had not sought eye care in the preceding 12 months were asked the main reason why. We categorized the reasons as cost/lack of insurance, no need, no eye doctor/travel/appointment, and other (meaning everything else). We used multinomial logistic regression to control for race/ethnicity, education, income, and other selected covariates.

Results Among adults with diagnosed diabetes, non-adherence to the recommended annual eye examinations was 23.5%. The most commonly reported reasons for not receiving eye care in the preceding 12 months were “no need” and “cost or lack of insurance” (39.7% and 32.3% respectively). Other reasons were no eye doctor, no transportation or could not get appointment” (6.4%), and “other” (21.5%). After controlling for covariates, adults aged 40-64 were more likely than those aged ≥65 years (relative risk ratios [RRR]=2.79; 95% CI =2.01, 3.89) and women were more likely than men (RRR=2.33; 95% CI=1.75, 3.14) to report “cost or lack of insurance” as their main reason. However, people aged 40-64 were less likely than those aged ≥65 years to report ”no need” (RRR=0.51; 95% CI=0.39, 0.67) as their main reason.

Conclusion Addressing concerns about “cost or lack of insurance” for adults under 65 years and “no perceived need” among those 65 years and older could help improve eye care service utilization among people with diabetes.

  • Received June 26, 2013.
  • Accepted August 29, 2013.

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