Harper Robert A, Hooper Jeremy, Parkins David J, Fenerty Cecilia H, Roach James, Bowen Michael
Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, UK.
Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Ophthalmic Physiol Opt. 2025 Jan;45(1):294-300. doi: 10.1111/opo.13399. Epub 2024 Oct 8.
Socioeconomic deprivation is associated with an increased incidence of sight-loss. To inform potential developments in eyecare, General Ophthalmic Service (GOS) sight-testing activity was explored in relation to deprivation for GOS contractors submitting National Health Service (NHS) claims in England.
Data on NHS sight-test claims for the financial year 2022-2023 were sought from NHS England (NHSE), including number of sight-tests by GOS contractors, their unique Organisation Data Service codes and postcodes and age-bands of patients accessing sight-testing. Deprivation scores were assigned to contractor practices using the Index of Multiple Deprivation (IMD) and the average number of sight-tests for all contractors within each IMD decile calculated, allowing rate of sight-testing per 1000 population per decile of deprivation to be estimated using Office of National Statistics (ONS) Lower Layer Super Output Area mid-year population estimates. Inequality was examined using the Odds Ratio (OR) and slope and relative index of inequality measures (SSI and RII).
Overall, 12.94 million NHS sight-tests were provided by 5622 GOS contractors in England in 2022-2023. Most affluent decile GOS contractors undertook an average ~2200 NHS sight-tests, while in the most deprived decile, average NHS sight-tests per contractor was ~1100. Rate of sight-testing per 1000 population in the most deprived decile was one quarter of that in the most affluent, with an OR of 5.29 (95% CI 5.27-5.30), indicating those in the most affluent areas were ~five times more likely to access NHS sight-tests. Overall, SII and RII were 333.5 (95% CI 333.52-333.53) and 6.4 (95% CI 6.39-6.40), respectively, findings reflective of substantial inequality in uptake.
There remains substantial unwarranted variation in uptake of NHS sight-testing, with those in more affluent areas accessing sight-testing substantially more than those in more deprived areas. Strategies are required to facilitate primary care optometry to provide more equitable access to eyecare.
社会经济剥夺与视力丧失发病率增加有关。为了为眼科护理的潜在发展提供信息，我们针对在英格兰提交国民健康服务（NHS）索赔的普通眼科服务（GOS）承包商，探讨了与剥夺相关的GOS视力测试活动。
从英国国民健康服务体系（NHSE）获取2022 - 2023财年NHS视力测试索赔数据，包括GOS承包商的视力测试数量、其独特的组织数据服务代码和邮政编码以及接受视力测试患者的年龄范围。使用多重剥夺指数（IMD）为承包商诊所分配剥夺分数，并计算每个IMD十分位数内所有承包商的平均视力测试数量，从而可以利用国家统计局（ONS）下层超级输出区年中人口估计数估算每十分位数剥夺水平下每1000人口的视力测试率。使用优势比（OR）、斜率以及不平等的相对指数测量（SSI和RII）来检验不平等情况。
总体而言，2022 - 2023年英格兰的5622家GOS承包商提供了1294万次NHS视力测试。最富裕的十分位数的GOS承包商平均进行约2200次NHS视力测试，而在最贫困的十分位数中，每个承包商的平均NHS视力测试次数约为1100次。最贫困十分位数中每1000人口的视力测试率是最富裕十分位数的四分之一，优势比为5.29（95%置信区间5.27 - 5.30），表明最富裕地区的人接受NHS视力测试的可能性约为五倍。总体而言，SSI和RII分别为333.5（95%置信区间333.52 - 333.53）和6.4（95%置信区间6.39 - 6.40），这些结果反映出在接受服务方面存在严重不平等。
NHS视力测试的接受情况仍然存在大量不合理的差异，富裕地区的人接受视力测试的次数大大超过贫困地区的人。需要采取策略来促进初级保健验光服务，以提供更公平的眼科护理服务。
