Uncovering Disparities in Vision Health in Rural vs Urban Areas: Is There a Difference?

Abstract

Background: Blindness describes a condition in which patients have low vision, are legally blind, or totally blind. Disparities in vision health is a public health concern because it decreases quality of life and subsequently leads to a series of other health-related issues. These disparities exist across demographics, socioeconomic status, disease history, genetics, and geographic location, particularly in the urban vs. rural setting. Public health professionals need to shed light on these disparities to properly address them to ensure that individuals affected by blindness can receive proper care. Objective: To investigate if there are discrepancies or inequalities in vision care in a rural setting vs. urban setting. Methods: A multivariate binary logistic regression analysis using cross-sectional data from the Vision and Eye Health Surveillance System (VEHSS) was done using SAS Studio. Blindness, the outcome of interest, was defined as best-corrected visual acuity at less than 20/200 in the better-seeing eye. Each demographic subgroup was assessed in the counties included for upstate New York and downstate New York. Prevalence rates are expressed as a percent. Results: The multivariate binary logistic regression analysis showed that non-Hispanic black individuals from upstate New York and downstate New York were most likely to be blind compared to white, non-Hispanic, any Hispanic, and other individuals. Factors that were significantly associated with blindness include the female gender, individuals aged 65 years and older, non-Hispanic black individuals, and those without Medicare. Residents from upstate New York had a slightly increased likelihood to develop blindness, 1.04 (1.01, 1.07), compared to residents in downstate New York. Conclusions and Relevance: Blindness prevalence was highest in upstate New York, among non-Hispanic black individuals, the female gender, and individuals 65 years and older. Despite the blindness prevalence highest upstate, the difference was not clinically significant compared to downstate New York, despite a considerably larger number of resources present downstate compared to upstate. Given the severity of blindness as a public health concern, the discrepancies in eye care in urban vs. rural settings need to be investigated further.