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Frequency and source of prescription eyewear insurance coverage in Ontario: a repeated population-based cross-sectional study using survey data

Prem Nichani, Graham E. Trope, Yvonne M. Buys, Samuel N. Markowitz, Sherif El-Defrawy, Gordon Ngo, Michelle Markowitz and Ya-Ping Jin
March 17, 2021 9 (1) E224-E232; DOI: https://doi.org/10.9778/cmajo.20200104
Prem Nichani
Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont.
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Graham E. Trope
Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont.
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Yvonne M. Buys
Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont.
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Samuel N. Markowitz
Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont.
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Sherif El-Defrawy
Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont.
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Gordon Ngo
Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont.
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Michelle Markowitz
Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont.
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Ya-Ping Jin
Faculty of Medicine (Nichani), Institute of Health Policy, Management and Evaluation (Nichani), Department of Ophthalmology and Vision Sciences (Trope, Buys, Markowitz, El-Defrawy, Jin) and Dalla Lana School of Public Health (Jin), University of Toronto; Toronto Western Hospital (Trope, Buys, Markowitz), University Health Network; Kensington Eye Institute (El-Defrawy), Toronto, Ont.; Faculty of Medicine (Ngo), University of Western Ontario, London, Ont.; private practice (Markowitz), Toronto, Ont.
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Article Figures & Tables

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  • Figure 1:
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    Figure 1:

    Proportion of Ontarians with prescription eyewear coverage in 2005 and 2013–2014, by source of funding. Data for 2003 were unavailable. Error bars represent 95% confidence intervals.

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    Figure 2:

    Proportion of Ontarians with prescription eyewear coverage who had employer-sponsored plans in 2005 and 2013–2014, by the highest level of education attained in the household (A) and total household income (B). Data for 2003 were unavailable. Error bars represent 95% confidence intervals.

  • Figure 3:
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    Figure 3:

    Proportion of Ontarians with prescription eyewear coverage who had government-sponsored plans in 2005 and 2013–2014, by the highest level of education attained in the household (A) and total household income (B). Data for 2003 were unavailable. Error bars represent 95% confidence intervals.

Tables

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    Table 1:

    Weighted frequency and prevalence of insurance coverage for prescription eyewear among Ontarians aged 12 years or older in 2003, 2005 and 2013–2014 stratified by sociodemographic characteristics

    Characteristic200320052013–2014
    Frequency (n, 100’s)Prevalence (95% CI), %Frequency (n, 100’s)Prevalence (95% CI), %Frequency (n, 100’s)Prevalence (95% CI), %
    Total62 15562.3 (61.5–63.0)61 84662.1 (61.3–62.8)68 69462.0 (61.1–62.9)
    Age, yr
     12–19793669.2 (67.3–71.1)810667.6 (65.7–69.6)788767.4 (65.2–69.6)
     20–3920 98262.0 (60.6–63.4)19 93361.7 (60.4–63.0)20 72960.5 (58.8–62.1)
     40–6427 59868.7 (67.6–69.9)28 20968.9 (67.7–70.1)32 36770.7 (69.2–72.1)
     65–74358542.8 (40.8–44.9)343740.9 (38.9–42.9)501344.5 (42.5–46.5)
     ≥ 75205434.2 (32.1–36.3)216136.2 (33.8–38.6)269734.9 (32.9–36.8)
    Sex*
     Female31 45261.7 (60.7–62.8)30 90960.9 (59.8–61.9)34 72761.3 (60.0–62.5)
     Male30 70362.8 (61.7–63.9)30 93763.3 (62.3–64.3)33 96762.8 (61.4–64.1)
    Highest education level in household
     Less than secondary school graduation315143.2 (41.0–45.5)263042.5 (40.1–45.0)227337.4 (34.6–40.2)
     Secondary school graduation719257.9 (56.0–59.8)549355.9 (53.8–57.9)693953.0 (50.5–55.4)
     Some postsecondary344160.5 (57.4–63.7)285258.9 (55.3–62.5)199557.6 (52.3–62.9)
     Postsecondary school graduation46 13765.7 (64.8–66.6)46 51665.6 (64.7–66.5)55 65666.1 [65.1–67.1)
    Marital status
     Married/common-law39 38266.0 (65.1–66.9)39 17965.8 (64.8–66.8)42 93867.2 (66.1–68.3)
     Widowed177936.3 (33.9–38.6)171436.3 (33.8–38.8)183036.1 (33.6–38.6)
     Separated/divorced352656.9 (54.4–59.5)348057.0 (54.3–59.6)449054.5 (51.1–57.8)
     Single/never married17 43260.2 (58.7–61.7)17 45859.8 (58.5–61.1)19 23357.9 (56.2–59.5)
    Household income†
     Below middle level928541.6 (40.2–43.0)822938.7 (37.3–40.1)968238.2 (36.4–40.0)
     Middle level20 87865.6 (64.4–66.9)19 78564.2 (64.2–62.8]25 88960.8 (59.3–62.2)
     Above middle level24 88877.7 (76.5–78.9)28 16577.9 (76.8–79.0)33 12377.3 [76.1–78.5)
    Ethnic background‡
     White50 28664.7 (63.9–65.4)49 70064.4 (63.6–65.1)51 08564.4 (63.6–65.3)
     Non-White957952.2 (50.0–54.4)10 80553.1 (50.9–55.3)15 14054.3 (52.0–56.6)
     Aboriginal68972.4 (67.1–77.6)110967.6 (53.1–72.0)201571.7 (67.8–75.7)
    Immigrant status§
     Nonimmigrant45 68267.1 (66.3–67.8)45 92666.3 (65.6–67.1)49 03966.7 (65.8–67.6)
     Immigrant
      Within previous 9 yr305641.7 (38.1–45.2)358145.4 (41.8–49.0)349943.6 (39.1–48.0)
      10 yr or longer11 76254.8 (53.0–56.5)12 17355.3 (53.4–57.3)15 18755.0 (52.9–57.1)
    • Note: CI = confidence interval.

    • ↵* Self-reported as female or male.

    • ↵† Less than middle level = less than $40 000; middle level = $40 000–$79 999 in 2003 and 2005, $40 000–$89 999 in 2013–2014; above middle level = $80 000 or more in 2003 and 2005, $90 000 or more in 2013–2014.

    • ↵‡ White: self-identification as White; non-White: self-identification with a group other than White or Aboriginal; Aboriginal: self-identification as First Nations (Status or non-Status), Métis or Inuk (Inuit).

    • ↵§ Nonimmigrant: born in Canada; immigrant: not born in Canada.

    • View popup
    Table 2:

    Adjusted prevalence ratio (weighted) of having employer-sponsored and government-sponsored insurance among Ontarians in 2013–2014*

    VariableAdjusted PR (95% CI)
    Employer-sponsored insurance†Government-sponsored insurance‡
    Age, yr
     12–19 v. 40–641.31 (1.13–1.52)0.67 (0.63–0.72)
     20–39 v. 40–640.95 (0.91–0.99)0.72 (0.66–0.77)
     65–74 v. 40–640.59 (0.57–0.61)0.85 (0.68–1.05)
     ≥ 75 v. 40–640.47 (0.39–0.56)1.02 (0.72–1.45)
    Male v. female sex0.98 (0.93–1.03)1.00 (0.97–1.04)
    Highest level of education in household
     Less than secondary school graduation v. secondary school graduation0.79 (0.75–0.84)1.27 (1.06–1.53)
     Some postsecondary school v. secondary school graduation1.05 (0.95–1.16)1.23 (0.96–1.57)
     Postsecondary school graduation v. secondary school graduation1.12 (1.08–1.16)0.84 (0.67–1.05)
    Marital status
     Widowed v. married/common-law0.88 (0.72–1.07)0.82 (0.77–0.87)
     Separated/divorced v. married/ common-law0.86 (0.76–0.97)1.21 (1.10–1.32)
     Single/never married v. married/ common-law0.70 (0.60–0.81)1.60 (1.30–1.96)
    Household income
     Below middle level v. above middle level0.37 (0.35–0.40)3.64 (3.37–3.93)
     Middle level v. above middle level0.82 (0.78–0.85)1.25 (1.06–1.47)
    Ethnic background
     Non-White v. White0.95 (0.87–1.04)0.78 (0.58–1.06)
     Aboriginal v. White0.91 (0.83–0.99)3.26 (2.81–3.79)
     Immigrant v. nonimmigrant0.87 (0.86–0.89)0.69 (0.64–0.74)
    • Note: CI = confidence interval, PR = prevalence ratio.

    • ↵* All variables in the table were included in the regression model. Therefore, except for the variable being examined, all other variables were adjusted for.

    • ↵† Coverage provided by employers, unions, trade associations or student organizations, which usually have group policy numbers by which insured people in the affiliated organization can be identified. The unweighted sample sizes were 19 085 (insured) and 35 056 (total).

    • ↵‡ Government subsidies provided to those registered with specific programs (e.g., Ontario Works, Ontario Disability Support Program, Non-Insured Health Benefits program) or who identify with specific populations (e.g., veterans, refugees, First Nations, Inuit). The unweighted sample sizes were 3203 (insured) and 19 174 (total).

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Frequency and source of prescription eyewear insurance coverage in Ontario: a repeated population-based cross-sectional study using survey data
Prem Nichani, Graham E. Trope, Yvonne M. Buys, Samuel N. Markowitz, Sherif El-Defrawy, Gordon Ngo, Michelle Markowitz, Ya-Ping Jin
Jan 2021, 9 (1) E224-E232; DOI: 10.9778/cmajo.20200104

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Frequency and source of prescription eyewear insurance coverage in Ontario: a repeated population-based cross-sectional study using survey data
Prem Nichani, Graham E. Trope, Yvonne M. Buys, Samuel N. Markowitz, Sherif El-Defrawy, Gordon Ngo, Michelle Markowitz, Ya-Ping Jin
Jan 2021, 9 (1) E224-E232; DOI: 10.9778/cmajo.20200104
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