Visual Health Disparities by Race, Ethnicity Reported in Children in United States

Isdin Oke, MD

Disparities by race, ethnicity, and socioeconomic status in subjective and objective visual function were observed in adolescent children in the United States, according to new findings.

Those identifying as Black, Mexican American, low-income, or a non-citizen of the US were more likely to report poor subjective visual function and report worse objective visual acuity testing.

“Much of the visual impairment in this study appears correctable, which emphasizes the importance of access to refractive correction in adolescence, a time when poor vision may affect academic performance, future employment, and economic opportunities,” wrote study author Isdin Oke, MD, Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School.

Clarifying the link between race, ethnicity, and socioeconomic status and visual impairment in childhood could garner insight into vision health inequities and benefit opportunities for intervention.

The investigators performed a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008. They included all children between 12 and 18 years of age with a completed vision questionnaire and examination.

Study outcomes included subjective measures as self-reported poor vision and objective measures as visual acuity worse than 20/40 in the better-seeing eye. The sociodemographic factors examined consisted of age, sex, race and ethnicity, family income, household size, and US citizenship. 

Both multivariable logistic and linear regression analyses measured each sociodemographic factor with subjective and objective visual function, after adjusting for age, sex, race and ethnicity, family income, household size, and citizenship.

The study included a total of 2833 participants representing a survey-weighted 57 million adolescent children in the US. The mean age was 15.5 years and included 1407 female participants (49%).

From this population, 14% were identified as non-Hispanic Black, 11% were Mexican-American, 63% were non-Hispanic White, and 11% were other races and ethnicities. Investigators noted a total of 5% of participants were not US citizens and 19% had a family income below the poverty threshold.

In comparison to non-Hispanic White race and ethnicity, the prevalence of poor subjective visual function was greater among participants identifying as Black (11.8% vs 3.8%; 95% CI, 6.1% - 10.0%; P <.001) and Mexican American (11.9% vs 3.8%; 95% CI, 4.6% - 11.6%; P <.001).

The prevalence of poor subjective visual function was greater among non-US citizens compared with US citizens (13.1% vs 6.0%; 95% CI, 0.9% - 13.2%; P = .02), low-income families compared with higher-income families (13.8% vs 4.6%; 95% CI, 6.0 - 12.4%; P <.001), and large households compared with small households (8.8% vs 6.0%; 95% CI, 0.2% - 5.4%; P = .03).

Multivariable regression analysis revealed increased odds of poor subjective vision in Black participants (OR, 2.85; 95% CI, 2.00 - 4.05; P <.001), Mexican-American participants (OR, 2.83; 95% CI, 1.70 - 4.73; P <.001), and low-income participants (OR, 2.44; 95% CI, 1.63 - 3.65; P <.001).

Additional increased odds of low presenting visual acuity were observed among Black participants (OR, 2.13; 95% CI, 1.41 - 3.24; P = .001), Mexican American participants (OR, 2.13; 95% CI, 1.39 - 3.26; P = .001), and non-US citizens (OR, 1.96; 95% CI, 1.10 - 3.49; P = .02).

Oke noted limitations of the study data included the timeline, as it may not reflect the visual function of the current US adolescent population. However, an investigation into historical disparities might benefit physician practice as these patients enter early adulthood.

“Improving access to vision care services may decrease the burden of preventable visual impairment extending into adulthood," he added.

The study, “Association of Race, Ethnicity, and Socioeconomic Status With Visual Impairment in Adolescent Children in the US,” was published in JAMA Ophthalmology.