Patterns and factors associated with eye care utilization among adults over 65 in Taiwan: Findings from a national representative sample

Objectives: To investigate the pattern and factors associated with eye care utilization for elderly with and without self-reported eye diseases under a universal national health insurance program. Design: Population based cross sectional study. Methods: 1615 adults over 65 years old complete 2005 National Health Interview Survey (NHIS), and signed an informed consent agreed the linkage of NHIS to National Health Insurance (NHI) claim data were included. Eye care utilization was defined as having at least one claim of ophthalmologist visit in 2006. Multivariate logistic regression analysis was used to determine the factors. Results: 165(10.2%) reported having severe eye diseases (glaucoma, blindness, retinopathy and neuropathy) in NHIS, 1105(68.4%) had some other eye diseases. Eye care utilization among those with severe, some, and no eye diseases were 58.8%, 40.0% and 32.5%, respectively. Male (OR=0.64, p=0.002) and those without income (OR=0.58, p=0.045) were associated with less eye care for those with some eye diseases. Age over 80 (OR=0.22, p=0.033) and live in suburban area(OR=0.34, p=0.035) were associated with less eye care compared with those younger than 70 years and live in urban area in the severe eye disease group. Conclusions Even under a universal health insurance program, no income remains a significant factor associated with less eye care for elderly with eye diseases. Strategies should be developed for low socioeconomic groups to increase their eye care utilization. Adults over 80 years were less likely to follow up their eye diseases. Further research should be taken to explore the barriers in oldest age group.