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Ramsey Yusuf, Ram Sundaresh, Brad Richards, Kristen Harris Nwanyanwu; Risk Factors for Underutilization of Eye Care in the Evaluation of Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1080.
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Diabetic retinopathy (DR) is a leading cause of preventable blindness in the United States. Adherence to DR screening guidelines with routine dilated fundus examination (DFE) has been shown to vary between populations. We performed a cross-sectional study of primary care patients who received first-time referrals to ophthalmology for DR screening.
Patients ≥18 years old with diabetes and an ophthalmology referral for DR evaluation were queried from the electronic medical record of Yale-New Haven Health System between 2013-2017. Patients with evidence of DFE within 1 year of their earliest referral were considered adherent to their referral, otherwise they were considered non-adherent. These two groups were compared by age, sex, race/ethnicity, primary language, and insurance status. Univariate and multivariate logistic regression were used to evaluate the effects of these covariates on odds of referral adherence; Wald’s test was used to determine statistical significance. Analysis was conducted in R version 3.3.1. This study's methods were approved by the Yale IRB.
Of 1103 patients, the median age was 53 years and 57.7% were female. 53.3% of patients underwent DFE within 1 year of referral. In the multivariate model, parameters associated with statistically significant increased odds ratio (OR) of referral adherence included age (OR 1.02 per 1-year increase; 95% CI, 1.01-1.03) and speaking primarily a language other than English or Spanish (OR 2.06; 95% CI 1.08-4.04). Parameters associated with statistically significant decreased odds of referral adherence included African-American background (OR 0.56; 95% CI 0.39-0.80); being primarily Spanish speaking (OR 0.56; 95% CI 0.36-0.86); and being on Medicaid (OR 0.43; 95% CI 0.21-0.83) or uninsured (OR 0.32; 95% CI 0.14-0.69). There was no difference in referral adherence between male and female patients.
Approximately half of patients referred to ophthalmology for DR evaluation in the primary care setting underwent DFE within 1 year of referral at this urban institution. Risk factors associated with non-adherence to referral included African-American background, being primarily Spanish speaking, and uninsured status. Further investigation into the health and socioeconomic status of these populations is to be performed.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Table 1: Regression Analysis to Evaluate effect of Risk Factors on Referral Adherence for Diabetic Retinopathy.
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