abstract: '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.'
affiliation: 'Patel, S (Corresponding Author), Vanderbilt Univ, Dept Ophthalmol, Med
  Ctr, 2311 Pierce Ave, Nashville, TN 37232 USA.

  Besagar, Sonya; Finn, Avni; Padovani-Claudio, Dolly Ann; Sternberg, Paul, Jr.; Patel,
  Shriji, Vanderbilt Univ, Dept Ophthalmol, Med Ctr, 2311 Pierce Ave, Nashville, TN
  37232 USA.

  Yonekawa, Yoshihiro, Thomas Jefferson Univ, Wills Eye Hosp, Mid Atlantic Retina,
  Philadelphia, PA 19107 USA.

  Sridhar, Jayanth, Bascom Palmer Eye Inst, Dept Ophthalmol, Miami, FL 33136 USA.'
author: Besagar, Sonya and Yonekawa, Yoshihiro and Sridhar, Jayanth and Finn, Avni
  and Padovani-Claudio, Dolly Ann and Sternberg Jr., Paul and Patel, Shriji
author-email: shriji.patel@vumc.org
author_list:
- family: Besagar
  given: Sonya
- family: Yonekawa
  given: Yoshihiro
- family: Sridhar
  given: Jayanth
- family: Finn
  given: Avni
- family: Padovani-Claudio
  given: Dolly Ann
- family: Sternberg Jr.
  given: Paul
- family: Patel
  given: Shriji
da: '2023-09-28'
doi: 10.1001/jamaophthalmol.2022.4566
earlyaccessdate: NOV 2022
eissn: 2168-6173
files: []
issn: 2168-6165
journal: JAMA OPHTHALMOLOGY
keywords-plus: 'QUALITY-OF-LIFE; UNITED-STATES; OLDER-ADULTS; VISION; GLAUCOMA; IMPACT;

  RISK; AGE; UK'
language: English
month: DEC
number: '12'
number-of-cited-references: '37'
pages: 1219-1226
papis_id: e60e911d19aeb8d5bcde95e3faa39bd9
ref: Besagar2022associationsocioecon
times-cited: '6'
title: Association of Socioeconomic, Demographic, and Health Care Access Disparities
  With Severe Visual Impairment in the US
type: article
unique-id: WOS:000878749300002
usage-count-last-180-days: '3'
usage-count-since-2013: '4'
volume: '140'
web-of-science-categories: Ophthalmology
year: '2022'