Faculty of Medicine, McMaster University, Hamilton, Ont.
Faculty of Medicine, University of Toronto, Toronto, Ont.
Can J Ophthalmol. 2018 Aug;53(4):342-348. doi: 10.1016/j.jcjo.2017.11.012. Epub 2018 May 7.
Our prior study revealed significantly lower use of eye care providers in Newfoundland and Labrador (NFLD). This study reports factors associated with this low use and related vision health outcomes.
Cross-sectional survey.
A total of 14 925 Caucasian respondents to the Canadian Community Health Survey - Healthy Aging 2008/2009 aged ≥65 years.
Univariate and multivariate analyses were performed using self-reported survey data.
NFLD, along with 3 other provinces, does not insure seniors for routine eye examinations. Among seniors without self-reported glaucoma, cataracts, and diabetes, the use of eye care providers in NFLD (36.3%) is the lowest compared with provinces with (50.7%, p < 0.05) and without (42.2%, p > 0.05) government-insured eye examinations. Among seniors with known eye disease insured for eye care in all provinces, eye care utilisation in NFLD (63.1%) is still the lowest across all provinces (69.4%-71.3%, p > 0.05). Compared with the national average, NFLD seniors have significantly higher proportions of low income (61.7% vs 47.4%), no postsecondary education (53.6% vs 42.2%), and rural residency (40.6% vs 18.9%). These factors are all associated with low levels of eye care utilisation. Compared with insured provinces, NFLD has a significantly lower prevalence of self-reported cataracts (16.7% vs 23.1) and glaucoma (3.8% vs 7.0%), and a slightly higher prevalence of presenting visual impairment (4.0% vs 3.5%).
Lack of government insurance, low socioeconomic status, and living in nonurbanised areas all contribute to the underutilisation of eye care providers in NFLD. This underutilisation appears to be associated with reduced detection of eye diseases.
我们之前的研究表明，纽芬兰和拉布拉多省（NFLD）的眼科保健服务利用率明显较低。本研究报告了与这种低利用率相关的因素以及相关的视力健康结果。
横断面调查。
共有 14925 名参加 2008/2009 年加拿大社区健康调查-健康老龄化的白人受访者，年龄≥65 岁。
使用自我报告的调查数据进行单变量和多变量分析。
NFLD 与其他 3 个省一样，不为老年人的常规眼部检查提供保险。在没有自我报告青光眼、白内障和糖尿病的老年人中，NFLD 的眼科保健服务利用率（36.3%）与有政府保险的眼部检查的省份（50.7%，p<0.05）和没有政府保险的眼部检查的省份（42.2%，p>0.05）相比最低。在所有省份都有眼病保险的老年患者中，NFLD 的眼科保健利用率（63.1%）在所有省份中仍然最低（69.4%-71.3%，p>0.05）。与全国平均水平相比，NFLD 的老年人收入较低的比例显著较高（61.7%比 47.4%），没有接受过高等教育的比例较高（53.6%比 42.2%），农村居住比例较高（40.6%比 18.9%）。这些因素都与眼科保健利用率低有关。与有保险的省份相比，NFLD 自我报告的白内障（16.7%比 23.1%）和青光眼（3.8%比 7.0%）的患病率较低，而出现视力障碍的比例略高（4.0%比 3.5%）。
缺乏政府保险、较低的社会经济地位和居住在非城市化地区都导致了 NFLD 眼科保健服务利用率低。这种低利用率似乎与眼部疾病的检出率降低有关。
