Abstract
BackgroundSociological and economic risk factors of visual impairment have never been described in France at a national level as the association between the number of ophthalmologists per inhabitant and visual impairment prevalence.MethodsTwo national surveys were pooled. First, 2075 institutions were selected at random from the French Health Ministry files. Second, a random, stratified sample of 356,208 citizens living in the community was selected. Blindness and low vision (LV) prevalence rates were estimated by age and gender. Geographical equities were estimated by logistic regression adjusted on age and occupational category. The association between ophthalmologist density and visual impairment prevalence rate was estimated per region. Interviews were completed with 14,603 (94.9%) of 15,403 randomly selected subjects in institutions, and 16,945 (77.8%) of 21,760 randomly selected subjects in the community. Three groups were defined from the interviews: low vision, blind, and control.ResultsPrevalence rates were LV 2.08% and blindness 0.12%. Both rates increased exponentially with age. No major difference was found with gender. Injury was the declared reason for both LV (12%) and blindness (12%). Large regional differences in prevalence persisted for LV after adjustment on age and occupation (ORs: 0.35 to 2.10), but not for blindness. Regions with ophthalmologists below the national per capita average were usually those with higher LV prevalence.ConclusionAn inverse correlation was found between ophthalmologist number and LV prevalence rates for subjects of similar age and socio-professional category. This denoted possible inequity in the provision of healthcare.
Highlights
Sociological and economic risk factors of visual impairment have never been described in France at a national level as the association between the number of ophthalmologists per inhabitant and visual impairment prevalence
An inverse correlation was found between ophthalmologist number and low vision (LV) prevalence rates for subjects of similar age and socio-professional category
The surveys analysed shared two limitations: (1) their cross-sectional design did not allow an analysis of possible causalities between blindness, or low vision, and risk factors; and (2) the actual visual acuity of subjects who responded was not measured by ophthalmologists
Summary
Sociological and economic risk factors of visual impairment have never been described in France at a national level as the association between the number of ophthalmologists per inhabitant and visual impairment prevalence. It is crucial to obtain nationwide estimates of low vision and blindness prevalence to allocate the right amount of resources especially when life expectancy is predicted to increase [4,5]. Efficiency in resource allocation has become a major issue in public health decisions, but equity is very important, too, as stated by the National Institute for Clinical Excellence [17]. Equity and efficiency (cost per unit of production) are incompatible [18], so political decisions must be made. Such decisions should be based on studies aimed at quantifying acceptable levels of inequity, in order to accommodate fixed budgets. Little has been published on equity and eye care delivery [19]
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