Vision Testing Lowest in Adolescents Without Insurance

Uninsured and publicly insured children had a lower probability of a vision test provided by their primary care physician (PCP) compared with children who have private insurance, according to a research letter published in JAMA Ophthalmology.

Testing vision during adolescence is critical to catching any vision problems before it causes amblyopia. Vision testing is recommended starting at the age of 3 years by the American Academy of Pediatrics. This research letter aimed to quantify the vision testing rates through a PCP for individuals in the United States aged 3 to 17 years as well as to find the association between vision testing and insurance.

The National Survey of Children’s Health was used to pool data from 2018 to 2020. Parents and caregivers were asked if their child had received a vision test within the previous 12 months and where the test was taken. A pediatrician’s office or general doctor’s office was classified as a PCP. Parents and caregivers were also asked what their insurance status is: public only, private only, private and public, or no insurance. These were made into 3 categories of no insurance, public insurance, and private insurance, with the children who had both private and public being grouped into the public insurance group.

A multivariable logistic regression was used to calculate the odds of vision testing for each group based on insurance status as well as age.

There were 89,936 participants in the study; they had a mean (SD) age of 10.1 (4.3) years, and 51.8% were male. A total of 30.7% of the participants had received PCP testing for vision. The uninsured children had odds of vision testing that were decreased by 41% (odds ratio [OR], 0.59; 95% CI, 0.49-0.72) and the publicly insured children had odds decreased by 24% (OR, 0.76; 95% CI, 0.70-0.82) compared with children on private insurance.

The probability of PCP vision testing was found to be 22.0% (95% CI, 18.8%-25.2%) in children who were uninsured, 26.6% (95% CI, 25.3%-27.9%) for children who were publicly insured, and 32.3% (95% CI, 31.4%-33.2%) in children who were privately insured. The estimated probability of PCP testing for vision in children aged 3 to 5 years was 29.7% (95% CI, 25.6%-33.7%) in uninsured children, 35.2% (95% CI, 33.1%-37.3%) in publicly insured children, and 41.6% (95% CI, 39.8%-43.5%) for privately insured children.

There were some limitations to this study. The data were collected from parents and caretakers who may be unaware of vision tests or what they entailed, which could lead to underestimation or overestimation of the association between insurance and testing. The implications of gaps in insurance gap coverage were not analyzed. The results were also likely affected by the COVID-19 pandemic.

The researchers concluded that “PCP vision testing rate was low and differed by insurance status.” Less than half of children aged 3 to 5 years who were covered by private insurance received vision testing by a PCP. Future studies should focus on how to improve screening rates in that age group, according to the authors.

Reference

Killeen OJ, Choi H, Kannan NS, Asare AO, Stagg BC, Ehrlich JR. Association between health insurance and primary care vision testing among children and adolescents. JAMA Ophthalmol. Published online August 17, 2023. doi:10.1001/jamaophthalmol.2023.3644