Socioeconomic Determinants of Unmet Vision Care Needs and Gaps in Eye Examinations in Pediatric Populations from 2016 to 2022: Running Head: Unmet Pediatric Vision Care Needs.

OBJECTIVE To explore the relationship between socioeconomic factors and unmet vision care needs in children, with a temporal trend analysis including the impact of COVID-19 on eye examinations by an eye doctor. DESIGN Cross-sectional trend study PARTICIPANTS: Caregivers of non-institutionalized children ages 0-17 in each state METHODS: Using nationally representative data from the National Survey of Children's Health (NSCH), multivariable logistic regression analysis examined the relationship between forgone vision care and sociodemographic variables and analyzed trends in eye examination history from 2016 to 2022. MAIN OUTCOME MEASURES Unmet vision care needs and eye examination rates by an eye doctor RESULTS: Among children who were unable to obtain necessary vision services, caregivers most frequently cited cost (59.9%), challenges in securing an appointment (47.7%), and eligibility concerns (32.4%) as the primary barriers to care. Children lacking healthcare insurance (OR: 5.11 [2.24, 11.66], p<0.001) or experiencing coverage gaps (OR: 4.73 [2.20, 10.16], p<0.001) were significantly more likely to forgo necessary vision care. Income levels below 400% of the federal poverty level (FPL), especially at 0-99% of the FPL, were associated with a higher likelihood of not receiving needed vision care (OR: 2.56 [1.15, 5.71], p=0.048). Black non-Hispanic populations were significantly less likely to receive needed vision care than White non-Hispanic populations (OR: 2.97 [1.43, 6.16], p=0.003). When contrasting eye examinations by an eye doctor in previous years to 2022, the frequency of children who received examinations was higher across most demographic categories in 2016 compared to examinations in 2022 and were lowest in 2020 during the COVID-19 pandemic. CONCLUSIONS The study demonstrates a significant relationship between likelihood of receiving necessary vision care in children and socioeconomic factors such as insurance status, income, and race, with decreasing pediatric eye examinations over time that reached a low point in 2020 but started recovering in 2022. These results highlight the critical need for interventions targeting the most at-risk populations to reduce disparities in access to pediatric vision care and prevent long-term visual impairment in children.