Disparities in Eye Care Utilization During the COVID-19 Pandemic

Elam, Angela R.; Sidhom, David; Ugoh, Peter; Andrews, Chris A.; De Lott, Lindsey B.; Woodward, Maria A.; Lee, Paul P.; Newman-Casey, Paula Anne

PURPOSE: To assess the relationship between telemedicine utilization and sociodemographic factors among patients seeking eye care. DESIGN: Comparative utilization analysis. METHODS: We reviewed the eye care utilization patterns of a stratified random sample of 1,720 patients who were seen at the University of Michigan Kellogg Eye Center during the height of the COVID-19 pandemic (April 30 to May 25, 2020). The odds of having a video, phone or in-person visit compared to having a deferred visit. Associations between independent variables and visit type were determined using a multinomial logistic regression model. RESULTS: Older patients had lower odds of having a video visit (p=0.007) and higher odds of having an in-person visit (p=0.023) compared to being deferred, and in the non-retina clinic sample, older patients still had a lower odds of a video visit (p-0.02). Non-white patients had lower odds of having an in-person visit (p<0.02) in the overall sample compared to being deferred, with a similar trend seen in the retina clinic. The mean neighborhood median household income was $76,200 (±$33,500) and varied significantly (p<0.0001) by race with Blacks having the lowest estimated mean income. CONCLUSION: Disparities exist in how patients accessed eye care during the COVID-19 pandemic with older patients – those for whom COVID 19 poses a higher risk of mortality – being more likely to be seen for in-person care. In our affluent participant sample, there was a trend towards non-white patients being less likely to access care. Reimbursing telemedicine solely through broadband internet connection may further exacerbate disparities in eye care.