Equity in Uptake of NHS and Private Optometry Services in Wales by Age and Gender

Age and gender are fundamental social determinants of health, shaping disease patterns, healthcare utilisation and outcomes. Older adults often face barriers such as reduced mobility, digital exclusion and fragmented care pathways, while gender affects health through biological and sociocultural mechanisms. Therefore, equitable uptake of primary eye care is shaped by these factors. This study examined age and gender-related disparities in the uptake of primary routine National Health Service (NHS) and private eye care in Wales.

This cross-sectional study used an online questionnaire to capture practice activity over a retrospective 2-week period. Data included practice details and the number, age and gender of patients attending NHS and private eye examinations. Descriptive statistics summarised attendance by age group and sex. Associations between gender and age group were examined using chi-squared tests, odds ratios with 95% confidence intervals and two-sample proportion z-tests.

Responses were received from 289 contractors (83.3% of practices in Wales), recording 41,428 examinations. NHS and private funding accounted for 73.3% and 26.7% of the examinations, respectively. Females comprised 56.0% of NHS and 57.9% of private attendances. Utilisation was similar among those aged <18 and 19-59 years, while adults aged >60 years demonstrated substantially higher attendance. Female attendance predominated across most age groups.

Significant age and gender-related disparities in the uptake of eye care were identified. Women were more likely to attend across most age groups, with male predominance only in the oldest cohorts. Utilisation was similar among those aged ≤18 and 19-59 years, with substantially higher attendance among adults aged 60 and over. These disparities cannot be explained solely by disease prevalence, suggesting broader determinants, including socioeconomic, geographic and cultural factors may play a role. Ensuring equitable uptake requires gender-sensitive approaches, routine collection of disaggregated data and regular review of NHS policy frameworks.