Independent Impact of Area-Level Socioeconomic Measures on Visual Impairment

Abstract

Purpose.: It is known that a person's socioeconomic status (SES; individual-level SES) is closely correlated with his or her degree of visual impairment. Whether there is an independent relationship between area-level measures of SES (e.g., living in a lower SES environment) and visual impairment is unclear. This study describes the associations of area-level SES with visual impairment. Methods.: The authors conducted two population-based cross-sectional studies of 3280 adult Malays and 3400 adult Indians living in Singapore. Visual impairment was defined as LogMAR visual acuity >0.30 in the better-seeing eye. Area-level SES measures (e.g., proportion of people not speaking English, proportion of people with low income) were derived from the Singapore's 2000 population census. Results.: Increasing age and individual-level SES measures (including lower education level, lower income level, and lower occupational status) were significantly associated with increased odds of visual impairment. In analyses adjusting for age and individual-level SES measures, many area-level SES measures (e.g., higher proportion of people not using English, higher proportion of people with low income) were also significantly associated with increased odds of visual impairment. These associations were consistently observed in both Malays and Indians. Conclusions.: These data suggest that not only is a person's SES, but the SES of his or her immediate community, is associated with visual impairment. Further research is needed to investigate the underlying causes of visual health disparities and to improve the eye health of communities with lower SES.