Abstract
Purpose :
Early identification of diabetic retinopathy (DR) with screening eye examinations allows for secondary prevention of acquired vision impairment. This study aimed to determine the temporal change in prevalence of DR screening based on patient profiles in a representative Canadian population in an urban setting over ten years.
Methods :
This is an analysis of a nationally representative sample of patients with diabetes from the Ontario Diabetes health claims database for 2011-2015 and 2016-2020. The cohort was created using algorithms with ICD diagnosis codes applied to physician billing claims for adults aged 19 years and greater. Prevalence estimates, odds ratio (OR) and 95% confidence intervals (CI) for DR screening based on baseline clinical characteristics and sociodemographic factors were calculated.
Results :
Of 1,346,578 patients with diabetes, 455,027 (34%) had not been screened for DR in 2016-2020, which was higher than the number of unscreened patients in 2011-2015 (OR=0.93; 95% CI=0.92-0.93; p<0.001). The mean duration of diabetes amongst patients unscreened for DR increased between 2011-2015 to 2016-2020 (9.15±6.80 vs 10.67±7.02; p<0.001). Although DR screening amongst young adults of 20-39 years old increased from 2011-2015 to 2016-2020 (OR=1.17; 95% CI=1.14-1.20; p<0.001), this age group persistently had the highest proportion of unscreened patients than other age groups (58% for 20-39 years old vs 42% for 40-64 years old and 24% for 65 years and older). Immigrants were less likely to have been screened for DR compared to non-immigrants (OR=0.67; 95% CI=0.66-0.68; p<0.001). When patients were stratified by access to primary healthcare, those who had a family physician were more likely to be screened for DR (OR=2.31; 95% CI=2.26-2.36; p<0.001).
Conclusions :
Approximately a third of patients with diabetes in an urban setting in Canada have not been screened for DR. The proportion of unscreened patients has increased over the past decade with the population growth and chronicity of diabetes. Of all patients with diabetes, young adults, immigrants and those not under the care of family physicians are at highest risk of not being screened for DR. These findings guide resource allotment aimed at improving the rates of screening eye examinations for DR.
This is a 2021 ARVO Annual Meeting abstract.