Eye care utilization in Canada: disparity in the publicly funded health care system

Abstract

Objectives: To examine patterns in, determinants of, and barriers to eye care utilization in Canada. Design: Cross-sectional survey. Participants: All 132221 respondents to the Canadian Community Health Survey 2005. Methods: Eye care utilization was self-reported and was defined as having seen or talked on the telephone with an eye care provider (ophthalmologist or optometrist) in a 12-month period. Associations of interest were assessed by prevalence ratios (PR). Results: Forty percent (11 million) of Canadians aged 12 years or older reported utilization of eye care providers. The lowest utilization rates occurred in people aged 30–39 years and the highest in those aged 70 years and older. Utilization was not related to levels of education or household income in people with self-reported glaucoma, cataracts, or diabetes. Among Canadians without these conditions, significantly less utilization occurred in men, in those with less than a postsecondary education, and in those with annual household incomes under $30000. Canadians residing in Newfoundland and Labrador utilized eye care providers significantly less than those residing in other provinces (adjusted PR 0.80, 95% CI 0.74–0.86). Fourteen percent of glaucoma patients, 37% of diabetic patients, and 41% of people aged 65 years or older did not access eye care providers over a 12-month period. Conclusions: Marked disparities occur in eye care utilization among Canadians without known eye diseases. A substantial proportion of people at a high risk of vision loss do not access eye care providers. Attributable factors are likely incomplete government coverage, asymptomatic ocular diseases, and lack of perceived benefits of eye care services.