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Sociodemographic and health behavioural factors associated with access to and utilization of eye care in Korea: Korea Health and Nutrition Examination Survey 2008-2012
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Manuscript ID: Article Type:
Date Submitted by the Author:
bmjopen-2015-007614 Research 08-Jan-2015
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Complete List of Authors:
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Primary Subject Heading:
Epidemiology, Global health, Health economics, Health policy, Health services research PREVENTIVE MEDICINE, PUBLIC HEALTH, HEALTH ECONOMICS, Health economics < HEALTH SERVICES ADMINISTRATION & MANAGEMENT
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Keywords:
Health economics
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Secondary Subject Heading:
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Rim, Tyler Hyung Taek; Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Department of Ophthalmology Choi, Moonjung; Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Department of Ophthalmology Kim, Sung Soo; Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Department of Ophthalmology
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Original article
Barrier in eye care utilization and trend after economic crisis in 2008 in Korea: Korea health and nutrition examination survey 2008~2012 Tyler Hyungtaek Rim1*, Moonjung Choi1*, and Sung Soo Kim1,2 1 Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea. 2 Yonsei healthcare Big Data based Knowledge Integration System Research Center, and Institute of Convergence Science, Yonsei University College of Medicine, Seoul, Korea * Tyler Hyungtaek Rim and Moonjung Choi contributed equally to this work. Corresponding Author: Sung Soo Kim M.D., Ph.D. Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea
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Tel: 82-10-2191-6313 / Fax: 82-2-312-0541 / E-mail:
[email protected]
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Word count: 2,268
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Key Words: Health economic, Economic crisis, Economic recession, Eye care disparities, Eye care use, KNHANES
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ABSTRACT Objective: To determine the sociodemographic and health behavioural factors associated with access to and utilization of eye care in Korea. Design: nationwide cross-sectional study Methods: A total of 25,752 Koreans over the age of 30 were assessed from a national representative survey. We analysed independent variables of self-reporting eye clinic visits through multivariate analyses of sociodemographic factors. The time since the last visit to an eye clinic was used to assess access to and utilization of eye care. Results: Of the 25,752 respondents, 8,237 (32.0%) visited an eye clinic in the past year, 11,028 (42.8%) were seen more than 1 year ago, while 6,487 (25.2%) had never seen an ophthalmologist. Eye clinic utilization was statistically associated with older age, female sex, higher household income, higher education levels, and living in an urban area. Middle aged men between 30 and 49 years of age were found less likely to receive eye care compared to the rest of the population, and the proportion who do plummeted after the financial crisis of 2008. Conclusions: Sociodemographic disparities in eye care utilization could be improved through public interventions that raise awareness and promote access to medical care.
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Strengths and limitations of this study To best our knowledge, this study is first to evaluate the association between economic crisis and eye clinic use based on nationwide population-based study. The economic recession that began in 2008 played a significant role in decreased use of eye care among middle-aged men, who are usually lead providers in households. The analyses are based on self-reported data, which are subject to recall bias.
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There have been numerous epidemiologic research studies on health disparities regarding accessibility and quality of care1 in a various medical fields.2-5 Many of these have dealt with inequalities due to racial and ethnic backgrounds,6 and some have focused on minority populations.7 However, reports on eye care utilization have been published in only a few countries, including the United States,8-13 Canada,14 and Australia.15 16 With the global population ageing, there is growing demand for vision and eye care since chronic ocular conditions occur more frequently in the elderly. Visual impairment is a major public health concern because it not only decreases the quality of life17 by interfering with daily activities18 and increasing morbidity19 and mortality,20 21 but it also causes great financial burden, adding to rapidly expanding health care expenditures. Although the asymptomatic nature of many eye diseases during early treatable stages highlights the importance of timely examination, a previous study has shown that a substantial percentage of people do not seek eye care despite being at high risk for visual impairment.8 This study aims to analyze realized access to eye care in Korea at the national level and explore the individual and contextual characteristics that may contribute to disparities and barriers to care.
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METHODS
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Study design A detailed description of the sampling, enumeration, visual acuity, and ocular examination procedures has already been published.22 We obtained data from the Korea National Health and Nutrition Examination Survey conducted by the Korea Centre for Disease Control and Prevention (CDC) from July 2008 to December 2012, which is an on-going nationwide cross-sectional epidemiological survey and examination of the non-institutionalized civilian population in South Korea. Annually, 4000 households in 200 enumeration districts are selected to represent the South Korean population using the stratified, multistage clustered sampling method based on the 2005 National Census ophthalmologic interviews, and records were collected from participants in July 2008. A detailed interviewer-administered questionnaire was conducted to collect relevant sociodemographic and medical information. The Epidemiologic Survey Committee of the Korean Ophthalmologic Society verified the quality of the survey, and the survey was also reviewed and approved by the Institutional Review Board of the Korea Centre for Disease Control and Prevention. All participants provided written informed consent. We followed the Declaration of Helsinki.
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Outcome variable Participants older than 30 years were asked when they were last administered an eye examination by an ophthalmologist. Possible responses included ≤1 month, >1 month and ≤1 year, >1 year and ≤3 years, >3 years, or never. Using multivariate logistic analysis, the outcome measures for an association between eye clinic use and sociodemographic and health behavioral risk factors were defined as the last visit to the eye clinic being 1 year and ≤3 years 4. >3 years 5. Never Sociodemographic factors Age
Sex
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men women
Monthly house income
Education
Residential area
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urban rural
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with without
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Spouse
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Table 2. factors associated with use of eye clinic - multivariate analysis (n=25,752) univariate OR multivariate OR Sociodemographic factors Age 30~39 40~49
P value
1.0(ref) 1.3
( 1.2 ~ 1.4 )
