Abstract
Purpose :
Social inequities in access to screening for diabetic retinopathy (DR) limit the effectiveness of this important public health intervention. We examined whether community-level outreach screening in China would improve equity in access.
Methods :
Using multinomial regression we compared the distribution of indicators of socioeconomic disadvantage (female sex, older age, lower educational attainment) and sight-threating diabetic retinopathy (STDR, severe non-proliferative or proliferative retinopathy and/or macular edema) between three groups of diabetic adults in Guangdong province, China: people with diabetes presenting spontaneously for eye examinations at secondary-level hospitals (n=193); those screened through a primary-level DR outreach program (n=185); and individuals with newly- or previously-diagnosed diabetes examined as part of a population-based survey (n=579). The population-based cohort was used as the reference, reflecting the “ideal” reach of a screening program. All studies received approval from the Ethics Committee of the Zhongshan Ophthalmic Center, Guangzhou, China.
Results :
Routine eye care through secondary-level hospitals, as compared to population-based screening, appeared to be less likely to reach older adults (≥75y vs. <75y, OR=0.32, 95% CI: 0.17-0.60) and those with lower educational attainment (primary school or lower vs. middle school or higher, OR=0.08, 95% CI: 0.05-0.12), but not less likely to reach women (OR=1.10, 95% CI: 0.75-1.62). Similar patterns were observed when comparing community-level outreach screening to population-based screening, however, this strategy appeared to improve access when compared to spontaneous hospital presentation for older adults (OR=0.54, 95% CI: 0.33-0.89) and those with lower educational attainment (OR=0.26, 95% CI: 0.17-0.40). Again, women were as likely to be reached by community-level screening as by population-based screening after accounting for age and educational attainment (OR=1.15, 95% CI: 0.80-1.66). Compared to the population-based screening sample, the risk of STDR was higher in the primary-level hospital screening sample (OR=2.32, 95% CI: 1.13-4.75), and lower in the tertiary-level hospital sample (OR=0.23, 95% CI: 0.05-1.01).
Conclusions :
Community-level outreach screening for DR may improve access for older adults and those with lower educational attainment and may detect more sight threatening retinopathy.
This is a 2020 ARVO Annual Meeting abstract.