Vision Care Disparities by Nativity Among US Adults and Children: An Analysis of the 2023 National Health Interview Survey.

PURPOSE: To evaluate disparities in access to vision care among US-born and foreign-born adults and children in the United States, with particular attention to duration of US residence and language spoken with healthcare providers.

DESIGN

Retrospective cohort study.

SUBJECTS: US-born and foreign-born adults and children participating in the 2023 National Health Interview Survey.

METHODS

Data from the 2023 National Health Interview Survey were analyzed using survey-weighted methods. Outcomes included delayed medical care due to cost or transportation, receipt of an eye examination, vision testing history among children, and self- or parent-reported vision difficulty. Multivariable logistic regression models estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), adjusting for sociodemographic characteristics and insurance status. Among foreign-born adults, analyses were further stratified by years lived in the United States and language spoken with healthcare providers.

MAIN OUTCOME MEASURES: Delayed medical care due to cost or transportation, receipt of an eye examination in the past 12 months, lifetime vision testing among children, and vision-related functional outcomes.

RESULTS

Among 27,822 adults, foreign-born individuals had lower adjusted odds of receiving an eye examination in the past 12 months compared with US-born adults (aOR 0.91; 95% CI 0.84-0.98). Among foreign-born adults, use of a non-English language with healthcare providers was associated with lower odds of recent eye examination (aOR 0.66; 95% CI 0.53-0.83). Cost-related delays to care were more common in unadjusted analyses among foreign-born adults but attenuated after adjustment. Among 6615 children, those from foreign-born households had significantly lower odds of ever having undergone vision testing (aOR 0.50; 95% CI 0.36-0.69) and lower odds of receiving an eye examination in the past year (aOR 0.74; 95% CI 0.57-0.96).

CONCLUSIONS

The 2023 NHIS data identified possible disparities in access to preventive vision care for both immigrant adults and children. Language barriers and insurance-related factors primarily affected adults, whereas reduced exposure to preventive screening appeared to contribute to disparities among children. Targeted, age-specific strategies could potentially promote equitable access to vision care in immigrant populations.