Equity gaps in screening utilization for chronic eye conditions: Evidence from a population-based survey in Germany.

PURPOSE: To examine sociodemographic and health-related factors associated with the utilization of preventive ophthalmologic examinations in Germany and to explore determinants of out-of-pocket payment, with attention to equity gaps among different socioeconomically groups. METHODS: Data were derived from a population-based, demographically representative self-reported online survey of 1,008 adults conducted in Germany. All data were analysed descriptively, followed by binary logistic regression analyses. Sociodemographic and health-related factors were assessed. The primary outcome was the utilization of preventive eye examinations within the past 12 months; out-of-pocket payment served as the secondary outcome. RESULTS: Overall, 35.8% of respondents reported having undergone a preventive ophthalmologic examination within the previous 12 months. In multivariable binary logistic regression models, being in a relationship (OR 1.49, p = 0.036), existing eye disease (OR 3.81, p < 0.001), and recent general practitioner visits (OR 7.27, p < 0.001) or optician visits (OR 4.22, p < 0.001) were significantly associated with higher utilization of preventive services. In univariable binary logistic regression, younger age, employment status, academic degree, higher income, good self-rated health and optician visits were each associated with a higher likelihood of paying out-of-pocket for preventive ophthalmologic examinations, not reaching significance in a multivariable model. CONCLUSION: Preventive ophthalmologic examinations in Germany are primarily utilized by individuals who already have established contact with the healthcare system or have diagnosed eye diseases, while sociodemographic differences in out-of-pocket payments for preventive eye examinations were observed mainly in univariable analyses and should be interpreted cautiously. The findings may inform future prevention strategies aimed at improving low-threshold access to preventive eye care, particularly among individuals without regular contact with healthcare providers.