Term of Award

Fall 2020

Degree Name

Doctor of Public Health (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Department of Health Policy and Community Health

Committee Chair

Yelena Tarasenko

Committee Member 1

Linda Kimsey

Committee Member 2

Gulzar Shah


Diabetic retinopathy (DR) is a prevalent cause of vision impairment and blindness among adults in the United States. Early diagnosis of DR through dilated eye examinations can reduce the risk of vision impairment or loss. Differences in eye examination rates by race and ethnicity have been suggested by prior studies emphasizing importance of increasing insurance coverage and access to care among minority populations. The Affordable Care Act aimed to expand health insurance coverage and improve access to care. This study examined trends overall and by race and ethnicity in eye examination rates and the contribution of Medicaid expansion on changes in eye examination rates among U.S. adults with diabetes living below 138% of the federal poverty level (FPL). This research utilized data from the 2010-2017 Medical Expenditure Panel Survey. Univariate and multivariable logistic regression models with post-estimation commands were fit to assess changes in eye examination rates overall, by race and ethnicity, and by residence in a state that expanded or did not expand Medicaid, while controlling for predisposing, enabling, and need factors, as conceptualized by the Andersen Healthcare Utilization model.

Results: Eye examination rates did not significantly change among non-Hispanic whites, non-Hispanic blacks, and Hispanics from 2010-2017. The fully adjusted model revealed no significant differences in eye examination rates between the three racial and ethnic subgroups and in individuals with diabetes living below 138% of the FPL in expansion vs non-expansion states. Between 2010 and 2017, no significant improvements in eye examination were noted among non-Hispanic whites, non-Hispanic blacks, and Hispanics, and Medicaid expansion was not associated with changes in eye examination rates. Research on public health interventions targeting other factors that influence eye screening is warranted as expanding access to insurance coverage alone did not appear to translate into improvements in eye examinations.

OCLC Number


Research Data and Supplementary Material