Immigration Status and Utilization of Optometry Services in the United States

Purpose: To characterize utilization of office-based optometry services by immigration status using a nationally representative database.

Methods: 2007-2011 Medical Expenditure Panel Survey is used to examine adults aged 18 years and older. Respondents were classified as US natives, naturalized citizens and noncitizens. Multivariate logistic regression analysis examined the relationship of having visited an office-based optometrist within 12 months by immigrant status, adjusting for age, gender, education, race/ethnicity, marital status, self-reported vision difficulty, use of corrective lenses, poverty status, insurance and usual source of care. Oaxaca-Blinder decomposition identified factors that perpetuate or ameliorate disparities in utilization across immigrant groups.

Results: Among respondents reporting vision difficulties, only 47.9% of noncitizens used corrective lenses compared to 71.0% of naturalized citizens and 71.6% of US natives. Adjusting for confounding factors, multivariate logistic regression showed naturalized citizens and noncitizen residents had significantly lower odds than natives of receiving optometry services (naturalized citizen adjusted odds ratio (AOR) 0.77, 95% confidence interval (CI) 0.66 to 0.89; noncitizen AOR 0.44, 95% CI 0.36 to 0.53). Decomposition analysis suggested that 17% of the disparity in utilization between noncitizens and US natives resulted from barriers to care such as language barriers, poverty, uninsurance, and not having a usual source of health care.

Conclusions: Prior literature suggests that immigrants have significantly poorer clinical vision outcomes than US natives. Our study findings show that immigrant patients may need targeted interventions that reduce barriers to care and change their perceptions so that regular eye care services are viewed as necessary and preventative.