Title : Risk factors for unmet vision care needs among U.S. Adults with diabetes: Findings from the 2023 national health interview survey
Abstract:
Background: Diabetes is a leading cause of visual impairment in the United States. Clinical guidelines recommend that adults with diabetes receive a comprehensive eye examination annually to detect and treat conditions such as diabetic retinopathy, diabetic macular edema, cataract and glaucoma that are often triggered by diabetes. Despite these recommendations, a substantial proportion of people with diabetes do not receive regular eye care. Identifying sociodemographic and health-related factors associated with unmet vision care needs is essential for reducing preventable vision loss and for informing both healthcare and public health strategies.
Objective: To examine the prevalence of and risk factors for unmet vision care needs among U.S. adults with self-reported diabetes using nationally representative data from the 2023 National Health Interview Survey (NHIS).
Methods: We analysed data from the 2023 NHIS Sample Adult file. Adults aged ≥18 years who reported having been told by a health professional that they have diabetes (excluding gestational diabetes) were included. Unmet vision care need among diabetics was defined as self-reported diabetes combined with not having had a dilated eye examination in the past 12 months. Multivariable logistic regression was used to identify clinical and demographic factors associated with unmet vision care needs.
Results: In this nationally representative sample of adults with diabetes, 32.8% reported not having an eye exam in the past year, and 12.3% cited cost-related barriers to care. The multivariate logistic regression indicated that younger adults with diabetes (<35 years) were significantly more likely to have unmet eye care needs (OR = 2.95, 95% CI [1.91, 4.54], p < .001). Lower educational attainment and household income below 200% of the federal poverty level were also significant risk factors (p < .05). There were no significant differences between men and women or among racial and ethnic groups. Lack of health insurance was strongly associated with unmet eye care needs (OR = 2.99, 95% CI [1.92, 4.66], p < .001). Self-rated general health was not significantly associated with unmet eye care need. While there was no significant difference between type 1 and type 2 diabetes, individuals who used insulin were significantly less likely to have unmet eye care needs (OR = 0.68, 95% CI [0.57, 0.81], p < .001). Additionally, those who had less frequent A1C testing were markedly less likely to receive comprehensive annual eye exams p<0.001.
Conclusions: Despite national guidelines, a substantial proportion of U.S. adults with diabetes do not receive recommended vision care. Sociodemographic disparities, including younger age, lower income, and lack of insurance, were key predictors of unmet need. Diabetics who were using insulin and those who had routine A1C testing were more likely to get annual comprehensive eye exams. Efforts such as targeted outreach, patient education, expanded insurance coverage for eye care, and community-based screening programs may help reduce preventable vision loss in this high-risk population.
