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Vision screening for preschoolers with commercial insurance: impact of geography
Afua O Asare1, Joshua J Horns2, Brian C Stagg1
1John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah; Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah.
Insights
Pediatric vision screening rates are low for US children aged 3-5 with commercial insurance. Children in rural areas have significantly lower vision screening rates compared to urban areas.
Area of Science:
- Public Health
- Ophthalmology
- Pediatrics
Background:
- The American Academy of Pediatrics advocates for early pediatric vision screening to address vision disorders during crucial developmental stages.
- Early intervention for vision disorders in children yields the most significant benefits.
- This study investigates vision screening rates in US children aged 3-5 with commercial insurance, comparing rural and urban populations.
Purpose of the Study:
- To determine the prevalence of vision screening among US children aged 3-5 with commercial insurance.
- To compare vision screening rates between children residing in rural versus urban areas.
- To identify potential disparities in access to pediatric vision care.
Main Methods:
- A cross-sectional study utilized commercial claims data from the Merative MarketScan Database (2011-2020).
- The study included 2,299,631 children aged 3-5 with commercial insurance.
- Adjusted incident rate ratios (aIRR) were calculated to compare vision screening rates in rural versus urban areas, controlling for relevant demographic and insurance factors.
Main Results:
- Overall, 28.8% of eligible children had a claim for vision screening.
- Children in rural areas exhibited a significantly lower adjusted incident rate of vision screening (15.1%) compared to those in urban areas (30.6%).
- The adjusted incident rate ratio (aIRR) for vision screening was 0.57 (95% CI, 0.53-0.61) for rural versus urban children.
Conclusions:
- Vision screening rates for preschool-aged children with commercial insurance are suboptimal.
- Significant disparities exist in vision screening access, with children in rural areas being underserved compared to their urban counterparts.
- These findings highlight the need for targeted interventions to improve pediatric vision screening in underserved rural populations.
Background:
The American Academy of Pediatrics recommends pediatric vision screening to detect and refer vision disorders during the critical early years when intervention yields the greatest benefits. We determined the rate of vision screening for US children 3-5 years of age with commercial insurance and compared rates among those living in rural versus urban areas. Children in rural compared with urban areas were expected to have lower rates of vision screening.
Methods:
A cross-sectional study using commercial claims for 3- to 5-year-olds derived from the Merative MarketScan Database (IBM, Armonk, NY), 2011-2020, was conducted. Primary outcome was the proportion of children with a claim for vision screening. Adjusted incident rate ratios (aIRR) of vision screening with 95% confidence intervals were computed for children living in rural compared with urban areas of the United States.
Results:
Claims for 2,299,631 children were included. Most children (1,724,923 [75.0%]) were enrolled in preferred provider organization plans and lived in urban areas (2,031,473 [88.3%]). A total of 662,619 (28.8%) had a claim for a vision screening. Children living in rural versus urban areas had a lower adjusted incident rate of vision screening (15.1 vs 30.6%, aIRR 0.57; 95% CI, 0.53- 0.61) after adjusting for sex, age, region, and insurance type.
Conclusions:
For preschool age children with commercial insurance, vision screening is low, especially in rural compared with urban areas.
