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

  • Author / Creator
    Hwang, Jongnam
  • 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.

  • Subjects / Keywords
  • Graduation date
    2013-11
  • Type of Item
    Thesis
  • Degree
    Doctor of Philosophy
  • DOI
    https://doi.org/10.7939/R39G5GN8J
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
    English
  • Institution
    University of Alberta
  • Degree level
    Doctoral
  • Department
    • School of Public Health Sciences
  • Specialization
    • Health Services and Policy Research
  • Supervisor / co-supervisor and their department(s)
    • Johnson, Jeffrey (Primary supervisor, Public Health Sciences)
    • Bowen, Sarah (Co-supervisor, Public Health Sciences)
  • Examining committee members and their departments
    • Asada, Yukiko (Department of Community Health & Epidemiology, Dalhousie University)
    • Rudnisky, Christopher (Faculty of Medicine & Dentistry)
    • Yasui, Yutaka (Public Health Sciences)