Social Determinants of Health and Barriers in Accessing Eye Care for Refugees in the Greater Toronto Area

大多伦多地区难民获得眼科保健服务的社会决定因素及障碍

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Abstract

PURPOSE: To evaluate ocular health status, vision-related quality of life, and access to eye care services among a multi-ethnic refugee population in the Greater Toronto Area (GTA). METHODS: Participants completed a structured survey capturing demographic, medical, and vision-related data. Descriptive statistics were employed to summarize and interpret the responses. Canadian population data were sourced from Statistics Canada and National Vision Health Reports. Participants were recruited during ophthalmic screening outreach visits at four refugee housing sites in the GTA, and were eligible if they were adults or mature minors residing in refugee homes after arriving in Canada as refugees or asylum seekers between October 2022 and October 2024. Proportions were converted to estimated counts for comparison, and harmonized categorical variables were analyzed using Pearson's Chi-Square or Fisher's Exact Test. Bivariate and multivariate logistic regression models were then used to assess associations between demographic, clinical, and psychosocial factors and two outcomes: difficulty coping with life due to vision and history of barriers to eye care. RESULTS: Among 94 refugee participants (mean age 46.5 years; 41% female), rates of recent eye exams (19.1%) and prescription glasses use (51.1%) were significantly lower than in the Canadian population (74.5% and 81.0%, respectively; p<0.0001). Over half (55.3%) were dissatisfied with their vision, and financial barriers (50%) were the most reported obstacle to care. Prior abuse was associated with greater odds of encountering barriers (OR=7.65, p=0.005), while dissatisfaction with vision (OR=0.11, p=0.025) and interference with daily activities (OR=233.0, p<0.0001) strongly predicted difficulty coping. CONCLUSION: Refugees face significant vision-related health disparities. Interventions should address access, government benefits, education, and psychosocial supports.

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