Overview

Abstract (English)

Abstract: Diabetic retinopathy (DR) is a major cause of visual impairment that ultimately impedes daily activities. Visual impairment caused by DR is manageable if diagnosed early. Despite comprehensive clinical guidelines, there is underuse of the recommended eye examinations among patients with diabetes in Canada. This dissertation comprises of four studies identifying 1) the existence of disparities in eye care services and visual impairment, 2) the socio-demographic determinants of socioeconomic disparities in eye care services and visual impairment, and 3) the socioeconomic factors associated with visual impairment and eye screening services among patients with diabetes. The results of three separate analyses indicate the presence of 1) socioeconomic disparities in eye care services at the provincial level and 2) income-related disparities in visual impairment and eye screening services at the national level. At the provincial level, income- and material deprivation-related disparities consistently showed a “pro-rich” pattern, while the social deprivation index indicated a “pro-poor” pattern. In addition, material deprivation index and place of residence (urban/rural) were important contributors to the observed income- and material deprivation-related disparities. The social deprivation-related disparity was explained mainly by social deprivation itself. At the national level, income-related disparities in eye screening services and preventive eye screening services revealed a “pro-rich” pattern while the disparity in visual impairment indicated a “pro-poor” pattern. The main contributor to the observed disparities in eye screening services was income while the disparity in visual impairment was predominantly related to age. In addition, an examination of socioeconomic factors associated with visual impairment and eye screening services among Canadians living with diabetes provided further evidence that demographic factors and duration of diabetes were associated with visual impairment. Regarding eye screening services and preventive eye screening services, income, patient’s experience in discussing diabetic eye complications with health professionals and having private insurance covering eye care appointment were associated with regular eye screening services. We have contributed new evidence on previously unexplored issues and our work highlights a need for developing health policy to alleviate the gap in the use of eye examination across different socioeconomic groups, and for studies providing a better understanding of the observed disparities.

Abstract (French)

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