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  • We recently came across this article about a team of dedicated doctors providing specialized medical care to individuals with disabilities and individuals with mental illness. The article focused on the eye care being given to Kevin Fitzgerald, a 56 year old man with severe autism who suffers from cataracts. There is a huge need for specialized eye care for individuals with ID/DD. The article states that “as many as 50 percent of people with intellectual disability have vision problems. And a far higher proportion of these disabled patients have severe vision problems compared to the general population.” However, there are also documented barriers and obstacles to utilization of health care such as vision care faced by individuals with ID/DD.

    The article prompted us to look at NCI data on eye/vision difficulties and access to eye exams/vision screening. For the purposes of this blog, we looked at the 2011-2012 administration of the Adult Consumer Survey.

    Seven percent (7%) of the total sample (n=11621) had limited vision or was legally blind. The NIH estimates that approximately 3% of the general population over the age of 40 has blindness or low vision. The US Preventative Service Task Force guidelines state that individuals with ID should get vision screenings at least yearly, as vision problems are more common in adults with ID than in the general population. Yearly vision screenings are also important because individuals with ID may be less likely to report vision issues, so vision screenings may be necessary to spot symptoms[ii]. Furthermore, individuals with ID may rely heavily on sensory input, so vision issues may disproportionately impact those with ID[iii].

    The following table demonstrates that a little under half of the sample with limited vision/legal blindness had not gotten a vision screening in the past year.   

    Last eye exam or vision screening

    limited   or no vision- legally blind

    no

    yes

    within   past year

    48.0%

    54.6%

    within   past 2 years

    19.7%

    18.3%

    within   past 3 years

    3.9%

    4.1%

    within   past 5 years

    2.3%

    2.0%

    5   or more years ago

    3.1%

    7.3%

    has   never had a vision screening

    1.9%

    1.4%

    don't   know

    21.1%

    12.4%

    Studies have shown that there may be differences in preventative healthcare utilization by residence type. Therefore, we decided to look at frequency of vision screening by residence type. The dataset used in the following analysis is composed of only those respondents who were reported to have limited vision or legal blindness.

     

    Last   Eye Exam or Vision Screening

    Residence Type

    Institution

    Community-based residence

    Independent home/apt

    Parents/relatives home

    Foster care/host home

    Other

    Within past year

    56.3%

    64.0%

    56.1%

    40.7%

    48.4%

    61.3%

    Within past  2 years

    20.0%

    20.5%

    22.7%

    14.2%

    9.7%

    29.0%

    Within past  3 years

    5.0%

    4.2%

    3.0%

    3.5%

    8.1%

     

    within past 5 years

    2.5%

    0.9%

    3.0%

    4.0%

     

     

    5 or more years ago

    11.3%

    1.8%

    1.5%

    15.9%

    8.1%

    3.2%

    Has never had a vision screening

     

    1.5%

     

    1.8%

    3.2%

     

    Don't know

    5.0%

    6.9%

    13.6%

    19.9%

    22.6%

    6.5%

    N

    80

    331

    66

    226

    62

    31

    As is evident from the above table, there appear to be differences in how recently an individual with ID/DD and diagnosed vision impairment/legal blindness has had a vision screening based on residence type. Based on a chi-squared analysis, there is a statistically significant relationship (residence type and most recent vision screening. For example, it appears that individuals living in a parent/relatives home are less likely to have had a screening within the past year or two years, and more likely to have had a screening 5 or more years ago.

     Interestingly, in a recent blog post we looked at racial and ethnic differences in utilization of preventive healthcare such as vision screenings. We found that African American, Non-Hispanic respondents were significantly more likely than White, Non-Hispanic respondents to have had an eye exam in the past year.

    Delving into the particulars of data can aid in the development of more targeted policies to address differences and disparities in receipt of healthcare such as vision screenings.

    As always, we’d love to hear your questions/comments. Dhiersteiner@hsri.org


    Wilkinson, J., Culpepper, L & Cerreto, M. (2007). Screening tests for adults with intellectual disabilities. J Am Board Fam Med: 20(4): 399-407

    [ii] Ibid.

    [iii] Ibid.

  • On April 25, 2013, NCI staff displayed a poster at Project Intersect: Health Disparities Research at the Intersection of Race, Ethnicity, and Disability: A National Conference. The conference was put on by the Oregon Health and Science University, and aimed to inform participants of racial and ethnic disparities in health faced by individuals with ID/DD, share research and brainstorm priorities for future research and action.

    NCI staff presented a poster entitled Race/Ethnicity and the Use of Preventive Care Among Adults with Intellectual and Developmental Disabilities. The poster detailed research in which we looked at differences in receipt of preventive care based on race/ethnicity. We looked at results from the 2011-2012 administration of the Adult Consumer Survey and for the purposes of the analysis, we looked at the race/ethnicities of Non-Hispanic White, Non-Hispanic African American and Hispanic. The final data set included 11,224 people.  Table 1 demonstrates the race/ethnic breakdown of the sample.

    Table 1: Race/ethnicity of sample

    Race/Ethnicity

    Frequency

    Percent of total

    African American, Non-Hispanic

    2,251

    20.1%

    Hispanic

    457

    4.1%

    White, Non-Hispanic

    8,516

    75.9%

    Total

    11,224

    100%

    Our analyses revealed that at least some differences based on race/ethnicity in use of preventive care may actually be the result of the effects of other demographic characteristics. These demographic characteristics include, for example, age, gender, state, primary language, level of mobility, type of residence,  support needed for behavioral issues, etc.

    After controlling for other demographic characteristics, there were significant differences by race/ethnicity in the receipt of the following preventive care:

    • Has had dentist visit in past year
      • African American, Non-Hispanic respondents are significantly less likely than White, Non-Hispanic respondents to have had a dentist visit in the past year
    • Has had eye exam in past year
      • African American, Non-Hispanic respondents are significantly more likely than White, Non-Hispanic respondents to have had an eye exam in the past year
    • Has had flu vaccine in past year
      • African American, Non-Hispanic respondents are significantly less likely than White, Non-Hispanic respondents to have had a flu vaccine in the past year

    After controlling for other demographic characteristics, there were not significant differences by race/ethnicity in the receipt of the following preventive care:

    • Has primary care doctor
    • Has had physical exam in past year
    • Has had hearing test in the past five years
    • Has ever had pneumonia vaccine

    These findings were very interesting, and opened the door for more research.

    If you have any questions on this analysis, feel free to contact Dorothy at dhiersteiner@hsri.org

    POSTER_RE_Health_FINAL.pptx