Socioeconomic Disparities in Ophthalmology Services among Diabetic Patients in Alberta

Abstract

Screening for diabetic retinopathy (DR) is recommended by the Canadian Diabetes Association (CDA) Clinical Guidelines in order to detect disease timely and prevent blindness. Despite this recommendation, the rate of DR screening services in diabetic patients in Alberta has decreased over the past years. The aim of this study was to examine socioeconomic status (SES)-related disparities in the use of ophthalmologists’ services for diabetic patients in Alberta. This study used data from the Alberta Diabetes Surveillance System (ADSS), including visits to ophthalmologists between 1996 - 2009. The entire diabetic population in Alberta(86,935 in 1996, 121,014 in 2001, 170,888 in 2006 and 205,726 in 2009) was included in the analysis. SES disparities in ophthalmologist visits were assessed using the Concentration Index (CI), which ranges from -1 to +1. Pampalon's material and social deprivation indices, at Alberta's sub-region level, were used as SES measures. We found that disparities in use of ophthalmology services exist in diabetic patients, although the magnitudes of the disparities have steadily decreased over time. More socially deprived groups are more likely to use ophthalmology services compared to less socially deprived groups (CI- 1996:+0.070; 2001:+0.050; 2006:+0.045; 2009:+0.043). On the other hand, less materially deprived groups are more likely to receive ophthalmologist services (CI-1996:-0.073; 2001:-0.048; 2006:-0.035; 2009:-0.029). Further stratification by age, sex, geography and First Nation status needs to be considered. Our findings suggest the need to develop a policy to reduce both social and material deprivation-related disparities in the provision of ophthalmology services in diabetic patients.