Are there inequities in the utilization of childhood eye care services in relation to socioeconomic status? Evidence from the ALSPAC cohort

¹ Dept of Social Medicine, University of Bristol, United Kingdom
² Bristol Eye Hospital and Centre for Child and Adolescent Health, University of Bristol, United Kingdom

^* To whom correspondence should be addressed. E-mail: cathy.williams{at}bristol.ac.uk.

Accepted 30 March 2008

	Abstract

Background: Equity of access to eye care in childhood remains poorly researched and most studies report data on utilization without any objective measure of clinical need.

Participants/Method: 8271 participants from the Avon Longitudinal Study of Parents And Children (ALSPAC), a longitudinal birth cohort who were seen at age 7, when they underwent a comprehensive eye examination and details of family history of eye conditions, vision problems and contact with eye care services were obtained.

Results: 2931 (35.4%) children had been in contact with an eye care specialist and 1452 (17.6%) had received vision screening. Compared to social class I, the prevalence of eye disease was higher in the lower groups (social class IIIM, IV, V) (odds ratio 1.69, 95% CI 1.15-2.46). However, children from lower socioeconomic status groups were less likely to see an eye care specialist (odds ratio 0.83, 95% CI 0.70-1.00) or to use screening services (OR 0.65, 95% CI 0.43-0.98).

Discussion/Conclusion: The differences in the trends between socioeconomic groups in eye conditions and utilization of services suggest inequitable access to services. Our data highlight the limitations of community-based pre-school vision screening, which fails to abolish this inequity. It is important that future research explores the reasons behind these patterns. Compulsory school-entry vision screening, as recommended by the National Screening Committee and the Hall Report may redress this differential uptake of services.