Abstract
AimTo examine associations between uptake of free primary eye care, service availability (density of optometric practices) and service accessibility (household car access and drive time to nearest provider) after accounting for socioeconomic status and other individual, household and area factors.MethodsWe constructed a cohort of 294 870 community-dwelling adults aged 60 years, drawing contextual information from the 2011 Northern Ireland Census. Minimum drive times to the nearest optometry practice (1–19 min) and number of practices were derived for 890 geographical areas. The primary outcome was attendance at one or more publicly funded eye examinations to which all cohort members were entitled between 2009 and 2014. We used multiple log-binomial regression to estimate associations between eye care uptake, car ownership and drive time.ResultsEye examination uptake was 60.0%. 23.7% of the cohort had no car access, and these individuals had lower uptake than car owners (unadjusted risk ratio (RR) of uptake=0.86 (0.86, 0.87)). Among non-car owners, uptake decreased with drive time (longest vs shortest: RR=0.92 (0.88, 0.97)) with the largest decrease at 4 min drive time (approximately 1.5 miles). This pattern was weaker among car owners. These associations were independent of service availability, which was not associated with uptake.ConclusionBoth drive time and household car access were associated with eye care use, adjusting for individual, household and area factors. Policies to improve uptake should target those with no car access, especially those beyond walking distance from the nearest eye care provider.
Highlights
Chronic eye conditions leading to visual impairment significantly reduce quality of life and increase care costs for older people.[1 2]
Regular eye examinations ensure uncorrected refractive error is addressed, a significant risk factor for occurrence of hip fractures due to falls,[3,4,5] themselves associated with high recovery costs.[6 7]
Eye examinations were matched to an individual at any of the addresses at which they had lived during the study period
Summary
Chronic eye conditions leading to visual impairment significantly reduce quality of life and increase care costs for older people.[1 2]. Regular eye examinations ensure uncorrected refractive error is addressed, a significant risk factor for occurrence of hip fractures due to falls,[3,4,5] themselves associated with high recovery costs.[6 7] Despite these benefits, uptake of eye care among older people is often lower than recommended by eye care professionals.[8 9] Barriers to uptake include poor knowledge of the risk of eye diseases and the need for eye examinations and perceived difficulty of visual tests.[10,11,12] Individual socioeconomic status (SES) is strongly associated with uptake of eye care where upfront costs are high,[13] but evidence for this association is equivocal where costs are lower (eg, among older people in the UK who are eligible for free eye examinations and subsidised spectacles).[14] Associations between eye care uptake and area-level SES have been reported in several contexts,[15 16] and area deprivation is a risk factor for increased severity of glaucoma and AMD at presentation.[17 18] Only recently have researchers begun to untangle whether associations stem mainly from the characteristics of individuals or their areas of residence. The challenge now is to discover how area characteristics influence the individual decisions underpinning access to eye care services
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