Michigan Journal of Medicine

Introduction

Native, or American Indian, individuals disproportionately experience disparities in healthcare¹, including increased disease burden of hypertension² or diabetes³ as well as the impacts of the social determinants of health. There are few studies evaluating disparities in Native eye healthcare. This study aims to identify the experiences of and barriers to eye healthcare amongst Native Individuals.

Methods

This was a cross-sectional study conducted at the 2023 University of Michigan Annual Dance for Mother Earth Powwow in Ann Arbor, Michigan. Characteristics of 85 survey responses included in the study were summarized using descriptive statistics. Associations between participant characteristics and their responses about eyesight and eye care were investigated using cross tables and tested by Chi-square or Fisher exact tests. Adjustment for multiple comparisons was performed with Holm’s procedure, and all analyses were performed using R version 4.2.3 (R Foundation for Statistical Computing, Vienna, Austria).

Results

Half of the survey respondents were affiliated with American Indian nations or tribes located in Michigan (54.8%, n= 46). Self-reported ophthalmologic conditions included cataracts (n=12, 14%), glaucoma (n=3, 3.5%), macular degeneration (n=2, 2.4%), diabetic retinopathy (n=1, 1.2%), and other diseases (n=12, 14.1%). Respondents reported worse outcomes in general visual function (76.5, SD=16.2 compared to national average of 92, p <0.001) and in mental health (65.3, SD=26.8 compared to national average of 92, p<0.001). A third of participants (n=27, 31.8%) named at least one barrier to accessing eye healthcare, most commonly financial barriers. Trust in the health system and in providers was lower among survey participants compared to the greater United States population (46.4% vs 64% for the healthcare system, 58.9% vs 84% for providers).

Conclusions

Native respondents reported higher mistrust in the healthcare system as compared to the broader United States Community. One third of Native respondents had difficulties accessing eye healthcare. This indicates the role of underlying social determinants of health in American Indian eye healthcare access and emphasizes the importance of further study and work in this field.

References

1. Jones DS. The persistence of American Indian health disparities. Am J Public Health. 2006;96(12):2122-2134. doi:10.2105/AJPH.2004.054262

2. Benjamin EJ, Muntner P, Alonso A, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56-e528.doi:10.1161/CIR.0000000000000659

3. US Centers for Disease Control and Prevention. National diabetes statistics report 2020. Published 2020. Accessed April 20, 2023.https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf