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Permanent link (DOI): https://doi.org/10.7939/R39G5GN8J

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Socioeconomic Disparities in Eye Care Services and Eye Complications Among Diabetic Patients in Canada Open Access

Descriptions

Other title
Subject/Keyword
Eye screening service
Visual impairment
Diabetic patients
Deprivation index
Relative concentration index
Decomposition of relative concentration index
Socioeconomic status
Diabetic eye complication
Health disparities
Type of item
Thesis
Degree grantor
University of Alberta
Author or creator
Hwang, Jongnam
Supervisor and department
Johnson, Jeffrey (Primary supervisor, Public Health Sciences)
Bowen, Sarah (Co-supervisor, Public Health Sciences)
Examining committee member and department
Asada, Yukiko (Department of Community Health & Epidemiology, Dalhousie University)
Yasui, Yutaka (Public Health Sciences)
Rudnisky, Christopher (Faculty of Medicine & Dentistry)
Department
School of Public Health Sciences
Specialization
Health Services and Policy Research
Date accepted
2013-09-28T14:58:45Z
Graduation date
2013-11
Degree
Doctor of Philosophy
Degree level
Doctoral
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.
Language
English
DOI
doi:10.7939/R39G5GN8J
Rights
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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