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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)
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.
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.
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).
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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