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

Abstract

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. Retrospective cohort study. US-born and foreign-born adults and children participating in the 2023 National Health Interview Survey. 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. 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. 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). 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.