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Brief Report
December 2018

Disparities in Low-Vision Device Use Among Older US Medicare Recipients

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor,
  • 3Center for Eye Policy and Innovation, Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor
  • 4Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
JAMA Ophthalmol. 2018;136(12):1399-1403. doi:10.1001/jamaophthalmol.2018.3892
Key Points

Question  Are there sociodemographic disparities in the use of low-vision services among Medicare beneficiaries 65 years and older?

Findings  In this cross-sectional survey study of a nationally representative sample, older adults in the United States from minority racial/ethnic groups were less likely to report using low-vision devices but not vision rehabilitation compared with white individuals.

Meaning  If the associations from this study are confirmed, coverage of low-vision devices by Medicare may help to address a significant health care disparity in the use of this evidence-based intervention.

Abstract

Importance  Low-vision assistive devices are not covered by Medicare and many private insurers, although there is evidence that they can improve functioning and quality of life. Little is known about whether sociodemographic disparities exist in the use of low-vision services by Medicare beneficiaries.

Objective  To determine if sociodemographic disparities exist in the use of low-vision services by Medicare beneficiaries.

Design, Setting, and Participants  Cross-sectional population-based survey. The National Health Interview Survey is an annually administered nationally representative US survey. Data used in this study were from the 2002, 2008, and 2016 National Health Interview Survey vision supplement. Participants who were Medicare beneficiaries 65 years and older with self-reported vision impairment were included.

Main Outcomes and Measures  Multivariable logistic regression was performed to evaluate if sociodemographic or economic factors were associated with self-reported use of low-vision devices or low-vision rehabilitation among Medicare beneficiaries 65 years and older who self-reported vision impairment.

Results  There were 3058 participants included in the study. The survey weighted proportion of participants who were men was 37.9% (95% CI, 35.8%-40.0%), while 79.1% (95% CI, 77.2%-80.9%) were non-Hispanic white, 10.2% (95% CI, 9.0%-11.5%) were non-Hispanic black, 6.7% (95% CI, 5.6%-8.1%) were Hispanic, and 4.0% (95% CI, 3.2%-5.0%) identified with another race/ethnicity. The weighted proportion who reported using low-vison devices and low-vision rehabilitation were 26.1% (95% CI, 24.2%-28.1%) and 3.5% (95% CI, 2.8%-4.3%), respectively. In a model adjusted for ocular diagnoses, Hispanic individuals (odds ratio, 0.61; 95% CI, 0.39-0.97) and individuals from other races/ethnicities (odds ratio, 0.39; 95% CI, 0.19-0.80), but not black individuals, were significantly less likely to report using low-vision devices than white individuals. In the model that was not adjusted for ocular diagnoses, black individuals (odds ratio, 0.73; 95% CI, 0.54-0.99) were also significantly less likely to report using low-vision devices. There were no significant racial/ethnic disparities for reported use of low-vision rehabilitation.

Conclusions and Relevance  Additional research is needed to clarify the association between sociodemographics and use of low-vision services in the Medicare population. However, policy makers could consider expanding Medicare coverage to include low-vision devices in an effort to address significant disparities in the use of this evidence-based intervention.

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