Association between diabetic macular edema and mortality independent of retinopathy (R) grade - The North East London Diabetic Eye Screening Programme (DESP) Study

Abstract

Purpose : The UK DESPs offer annual diabetic eye screening to all people with diabetes aged ≥12 years. We examined associations of all-cause mortality in people undergoing population diabetic eye screening in the North East London DESP.

Methods : Retrospective cohort study (Jan 2012-Dec 2021) from the North East of London DESP with 176,876 people with diabetes. Cox model adjusting for age, sex, ethnicity, type and duration of diabetes, diabetic retinopathy (DR) severity (coded as per NSC-UK classification system in order of increasing severity: R0M0, R1M0, R1M1, R2M0, R2M1, R3M0, R3M1), and deprivation (quintiles of the index of multiple deprivation) examined associations with all-cause mortality.

Results : There were 28,988 deaths over a median of 7.91 years (IQR 4.47-10.19). Compared with people with no retinopathy at first screen, people with R3M1 had a 2.40-fold increase in hazards of death (95%CI 2.18-2.64, p<0.001). Each step rise in DR severity was associated with a 19% increase in hazards of death (p linear trend <0.001). Compared with white people, non-white ethnicities showed lower hazards of death, with Chinese (HR 0.51, 95%CI 0.43-0.61), any other Asian (HR 0.54, 95%CI 0.50-0.57), and south Asian (HR 0.64, 95%CI 0.62-0.66) people showing the greater effect sizes. Compared to people with highest deprivation, the least deprived people showed a HR of 0.73 (95%CI 0.69-0.77, p linear trend <0.001). Males had a 23% increase in hazards of death when compared to females (p<0.001). Every 5-year rise in duration of diabetes was associated with a 9% increase of hazards of death (p<0.001). Every 5-year increase in age at first screen showed a 54% increase in hazards of death (p for linear trend <0.001) and all reported HR are mutually adjusted for all covariates.

Conclusions : DR at first screen is an important determinant of all-cause mortality in diabetic eye screening. Diabetic macular edema increases the risk of death independent of R grade. In a universal healthcare setting where health care delivery is limited by system capacity rather than by patient’s economic circumstances, such as the NHS, deprivation is still associated with mortality. Further work including laboratory and fundus images is needed to obtain better models to stratify people at risk of major diabetes complications from their first DR screening visit.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.