Vision Impairment Associated With Lower Preventive Screening Service Rates in Older Adults

Older Americans with vision impairment may be less likely to use cancer-related preventive services compared with their counterparts without vision impairment, according to a study published in JAMA Ophthalmology.

In addition to being cost-effective and helping decrease overall health care spending, preventive care services like screening tests, counseling, and immunizations can reduce morbidity and mortality for older adults.

However, “vision impairment prevalence is estimated to range from 5.3% among United States adults aged 50 to 59 years, to 50.0% among those 80 years and older,” authors wrote. Individuals with vision impairment report greater barriers to access to care and limited access to health promotion information.

“Vision impairment is associated with negative health outcomes, such as heart disease, stroke, and cancer, and negative health care use patterns, including increased readmissions and high health care costs.” Poor health outcomes may be due in part to such barriers.

Using data from the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS), researchers examined the association between self-reported vision impairment and preventive care uptake among US adults aged 50 years and older.

Any adults who completed the Sample Adult questionnaire (part of the NHIS) in 2015 or 2018 were eligible for study inclusion. Those who completed the RFSS from 2016 to 2018 were also eligible. Preventive care services included in the study were breast cancer screening, colon cancer screening, influenza vaccination in the past year, or pneumococcal vaccination ever.

“Based on the eligibility for each outcome, 4 groups were constructed from each study yielding 8 analytic samples in total,” researchers said. Each of the samples ranged from 12,120 to 29,654 participants.

Vision impairment was defined as difficulty seeing and was self-reported by 14.3% of the population in the colon cancer screening group, 15.0% in the influenza vaccination group, 15.8% in the breast cancer screening group, and 16.3% in the pneumococcal vaccination group.

Analyses revealed that among participants in the vaccination groups, a higher proportion of individuals with vision impairment were age 80 years or older. “In all 4 populations, those with vision impairment were less likely than those without to be non-Hispanic White and more likely to be women (not applicable for the breast cancer screening group), have lower income, and have more comorbidities,” researchers found.

Compared with those without vision impairment, NHIS participants with vision impairment were:

• less likely to report breast cancer screening (odds ratio [OR], 0.82; 95% CI, 0.71-0.96)
• less likely to report colon cancer screening (OR, 0.89; 95% CI, 0.79-0.99)
• not less likely to report influenza vaccine (OR, 1.06; 95% CI, 0.97-1.15) and pneumococcal vaccination (OR, 1.03; 95% CI, 0.91-1.16)

BRFSS participants with vision impairment (5.9%-6.8%) were “less likely than those without vision impairment to report breast cancer screening (OR, 0.67; 95% CI, 0.59-0.75), colon cancer screening (OR, 0.70; 95% CI, 0.65-0.76), and pneumococcal vaccination (OR, 0.89; 95% CI, 0.81-0.99) but not influenza vaccination (OR, 0.95; 95% CI, 0.89-1.00).”

Overall, participants with vision impairment were less likely to report having received breast and colon cancer screenings but showed little to no differences in influenza or pneumococcal vaccination rates compared with controls.

Vaccinations are routinely offered at easily accessible locations while cancer screening tests may require more involved preparation. These processes may be challenging for visually impaired individuals to carry out.

Because the study was based on self-reported information, recall bias may have impacted clinical service use rates, marking a limitation to the study. Future studies ought to include longitudinal analyses that utilize objective measures of vision and medical record or health care claims data.

“Efforts to improve access to care among US adults with vision impairment should include preventive care, especially cancer screening,” researchers concluded. “Making health promotion information more accessible to those with low vision may help adults with vision impairment make more informed decisions.”

Reference

Assi L, Varadaraj V, Shakarchi AF, et al. Association of vision impairment with preventive care use among older adults in the United States. JAMA Ophthalmol. Published online October 29, 2020. doi:10.1001/jamaophthalmol.2020.4524