County-level characteristics and access to eye care and vision health status: A multilevel analysis

Objectives: The effect of contextual factors on health has been studied in fields of the health and social sciences. However, little is known on the effect of contextual factors on access to eye care and vision health. 

Method: We used data from the 2006-2010 Behavioral Risk Factor Surveillance System in 22 states to examine the association between contextual factors and access to eye care and vision health among U.S. adults aged ≥40 years (n=182,617). Access to eye care included eye care insurance coverage, visit to an eye doctor, or receipt of a dilated eye exam. Vision health status was defined as self-reported eye diseases, or near/distant vision function. Contextual factors included county-level demographic and socioeconomic characteristics. We used logistic regression with clustered robust standard errors method, adjusting for individual characteristics. Results were considered significant if P<0.05.

Results: The analyses showed that the county-level characteristics were significantly associated with access to eye care and vision health status independent of individual characteristics. For example, people living in counties with high levels of insurance coverage were more likely than residents in low coverage counties to report eye diseases. Adults living in counties with high median household income were less likely than those in low income counties to report eye diseases and more likely to have eye care insurance and receive dilated eye exams. 

Conclusion: Contextual factors were related to access to eye care and vision health.  Efforts to improve vision health and access to eye care may need to take into account the influence of contextual factors.