Measuring socioeconomic inequalities in eye care services among patients with diabetes in Alberta, Canada, 1995-2009.

Abstract

Diabetic retinopathy (DR) is a leading cause of blindness in Canada. Despite established comprehensive guidelines for routine DR screening, the rate of provision of diabetic eye care services by ophthalmologists in Alberta decreased in past years. The aim of this study was to examine socioeconomic status (SES)-related inequalities in the use of eye care services for patients with diabetes in Alberta, Canada. We used data from the Alberta Diabetes Surveillance System (ADSS), including visits to ophthalmologists over a 15-year period (1995-2009). Socioeconomic inequalities in the use of eye care services were assessed using the Relative Concentration Index (RCI). We used three different SES indicators: median household income and the Canadian material and social deprivation indices (MDI and SDI). Socioeconomic inequalities in use of eye care services exist in patients with diabetes, although the magnitudes of the inequalities were small and steadily decreased over time; income- and MDI-related RCI indicated that individuals with greater income or less material deprivation were more likely to use eye care services. However, for SDI-related RCI, socially deprived individuals were more likely to use eye care services (RCI: 1995: -0.066; 2002: -0.036; 2009: -0.028). Our findings suggest a need for attention to the potential impact of provincial policy on inequalities in eye care services among patients with diabetes, particularly as it relates to geographical differences across regional health zones.