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Mark Lane, Priscilla Mathewson, Hannah Sharma, Rob Barry, Helen Palmer, Maria Tsaloumas, Peter Shah, Alastair K Denniston; Social deprivation as a risk factor for late presentation of proliferative retinopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5349.
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Social deprivation is a significant barrier to accessing health care for a number of medical conditions, and has been associated with late presentation in glaucoma and cataracts. To determine if social deprivation is a risk factor for the late presentation of patients with proliferative diabetic retinopathy requiring urgent pan-retinal photocoagulation.
A retrospective 2:1 case control study. Data was collected for 102 patients referred by the UK National Screening Programme to Queen Elizabeth Hospital Birmingham between 01/06/2010 to 01/06/2012. The cases included 34 patients with proliferative (grade R3) retinopathy compared against a control group of 68 patients with lower retinopathy grades. Social deprivation was scored using the Index of Multiple Deprivation (IMD2007).
A significantly higher proportion of the case group (R3 patients) were in the lowest socioeconomic quartile when compared to the control population. Mean IMD score 47 (increased deprivation) for patients presenting with R3 retinopathy and 23 (decreased deprivation) for control patients (Mann Whitney, p = 0.0001). Median HBA1C was higher (11.5; 9.8-13.3 interquartile range) in patients presenting with R3 retinopathy than in controls (8.4, 7.3-9.3 interquartile range), p < 0.001, Mann-Whitney test). Ethnicity was associated with R3 retinopathy at presentation. South Asian ethnicity significantly increased the risk of being in the R3 group with 41% of R3 presentations being South Asian vs 18% in the comparator group; this compared with 56% and 76% respectively for White British patients (p < 0.0001, chi2 = 26.103; 1d.f.). 58% percent of the South Asian patients within this study presented with R3 retinopathy compared with only 26% of White British patients (two-tailed fishers exact test, p=0.007).
Social deprivation, and South Asian ethnicity appear to be associated with the late presentation of proliferative diabetic retinopathy. Our study supports the need to target these groups to reduce preventable blindness and to identify strategies to overcome their barriers to ophthalmic care.
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