Effect of deprivation on the progression of diabetic retinopathy and maculopathy: a multivariate analysis of 88,910 patients attending a South-East London diabetic eye screening service.

Abstract

Purpose : To determine any associations between deprivation using the index of multiple deprivation (IMD) and individual IMD subdomains with incident referable diabetic retinopathy/maculopathy (rDR).

Methods : Anonymised demographic and screening data collected by the South-East London Diabetic Eye Screening Programme were extracted from September 2013 to December 2019. Multivariable Cox proportional models were used to explore the association between the IMD, IMD sub-domains and rDR.

Results : From 110,316 people with diabetes who attended during the study period, 88,910 (81%) met the eligibility criteria. The mean (± standard deviation) age of included people with diabetes was 59.6 (± 14.7) years; 53.9% were male, 52.5% identified as White, 94.3% had type 2 diabetes, and the average duration of diabetes was 5.8 (± 6.9) years. rDR occurred in 7,113 patients (8.00%). Known risk factors of younger age, male gender, Black and Mixed ethnicity, baseline DR and diabetes duration conferred a higher risk of incident rDR. After adjusting for these known risk factors of rDR, the multivariable analysis did not show a significant association between IMD (decile 1) and rDR (hazard ratio [HR]: 1.07, 95% confidence interval [95%CI]: 0.87-1.34, p=.813). However, high deprivation (decile 1) in three IMD subdomains was associated with rDR, namely living environment (HR: 1.64, 95%CI: 1.12-2.41, p=.011), education skills (HR: 1.64, 95%CI: 1.12-2.41, p=.011) and income (HR: 1.19, 95%CI: 1.03-1.39, p=.022).

Conclusions : Using IMD subdomains allows for the evaluation of associations between specific aspects of deprivation and rDR, which may be otherwise missed when using the aggregate IMD as a measure of relative deprivation.

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