Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Int J Health Policy Manag. 2014 Oct 13;3(6):307-13. doi: 10.15171/ijhpm.2014.100. eCollection 2014 Nov.
The current study aimed to determine eye care utilization, to assess the role of economic inequality in the utilization of eye care services, and to identify its determinants in Shahroud, North of Iran.
Of the 6,311 invited people, 5,190 (82.24%) individuals aged 40 to 64 years old participated in the study. A history of a visit by an ophthalmologist or optometrist was considered as eye care utilization. The gap between low- and high-economic groups was decomposed into its determinants using the Oaxaca decomposition method.
Among the participants, 16.32% [95% Confidence Intervals (CI)= 15.31-17.33%] had never been examined by an ophthalmologist or optometrist, and 30.94% (95% CI= 29.69-32.20%) had not undergone an eye examination in the past 5 years. This negative history was significantly higher among female subjects [Odds Ratio (OR)= 1.79, 95% CI= 1.51-2.14], the low-economic group (OR= 2.33, 95% CI= 1.90-2.87), the visually impaired (OR= 1.41, 95% CI= 1.05-1.90), and the uninsured (OR= 1.93, 95% CI= 1.45-2.58). The negative history of eye examination decreased with increasing in age (OR= 0.94, 95% CI= 0.93-0.96) and education (OR= 0.94, 95% CI= 0.92-0.96). In this study, 24.72% (95% CI= 22.30-27.14) of the low-economic group and 9.94% (95% CI= 8.75-11.14) of the high-economic group had no history of eye examination. Decomposition of the gap between the two economic groups showed that education and gender were the most important determinants of inequality.
A considerable percentage of adults, even those with visual impairment, do not receive appropriate eye care. There is a definite economic inequality in the community for which poverty per se could be the major cause.
本研究旨在确定眼科保健的利用情况，评估经济不平等在眼科保健服务利用中的作用，并确定伊朗北部沙赫鲁德的决定因素。
在邀请的 6311 人中，有 5190 名（82.24%）40 至 64 岁的人参加了研究。将眼科医生或验光师的就诊史视为眼科保健的利用情况。使用 Oaxaca 分解方法对低经济组和高经济组之间的差距进行分解。
在参与者中，16.32%（95%置信区间（CI）=15.31-17.33%）从未接受过眼科医生或验光师的检查，30.94%（95%CI=29.69-32.20%）在过去 5 年内未进行过眼部检查。女性（优势比[OR]=1.79，95%CI=1.51-2.14）、低经济组（OR=2.33，95%CI=1.90-2.87）、视力障碍者（OR=1.41，95%CI=1.05-1.90）和未参保者（OR=1.93，95%CI=1.45-2.58）的这种负面检查史明显更高。眼部检查的负面历史随着年龄的增长（OR=0.94，95%CI=0.93-0.96）和教育程度的提高（OR=0.94，95%CI=0.92-0.96）而降低。在这项研究中，24.72%（95%CI=22.30-27.14）的低经济组和 9.94%（95%CI=8.75-11.14）的高经济组没有眼部检查史。对两个经济群体之间差距的分解表明，教育和性别是不平等的最重要决定因素。
相当一部分成年人，甚至是视力障碍者，都没有得到适当的眼科保健。社区中存在明显的经济不平等，贫困本身可能是主要原因。
