June 2020
Volume 61, Issue 7
ARVO Annual Meeting Abstract  |   June 2020
Outreach screening to address socioeconomic barriers to diabetic retinopathy screening in China
Author Affiliations & Notes
  • Gareth Mercer
    Ophthalmology and Visual Sciences, McGill University, Montreal, Quebec, Canada
  • Baixiang Xiao
    Zhongshan Ophthalmic Center, China
    Queen's University Belfast, Ireland
  • Han Lin Lee
    Queen's University Belfast, Ireland
  • Congyao Wang
    Zhongshan Ophthalmic Center, China
  • Tingting Chen
    Zhongshan Ophthalmic Center, China
  • Alastair K Denniston
    Queen Elizabeth Hospital Birmingham, United Kingdom
  • Catherine A Egan
    Moorfields Eye Hospital NHS Foundation Trust, United Kingdom
  • Nathan G Congdon
    Orbis, New York, United States
    Queen's University Belfast, Ireland
  • Footnotes
    Commercial Relationships   Gareth Mercer, None; Baixiang Xiao, None; Han Lin Lee, None; Congyao Wang, None; Tingting Chen, None; Alastair Denniston, None; Catherine Egan, None; Nathan Congdon, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 825. doi:
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      Gareth Mercer, Baixiang Xiao, Han Lin Lee, Congyao Wang, Tingting Chen, Alastair K Denniston, Catherine A Egan, Nathan G Congdon; Outreach screening to address socioeconomic barriers to diabetic retinopathy screening in China. Invest. Ophthalmol. Vis. Sci. 2020;61(7):825.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.


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