Back to Browse Journals » Clinical Audit » Volume 3

Sociodemographic differences in diabetic retinopathy screening; using patient-level primary care data for health equity audit

Authors Fraser SDS, Watkinson GE, Rennie CA, King D, Sanderson H, Edwards L, Roderick P

Published Date November 2011 Volume 2011:3 Pages 7—15

DOI http://dx.doi.org/10.2147/CA.S25313

Published 10 November 2011

Simon DS Fraser1, GE Watkinson2, CA Rennie3, D King2, H Sanderson2, L Edwards4, P Roderick1
1Public Health Sciences and Medical Statistics, University of Southampton, Southampton General Hospital, Southampton, 2NHS Southampton City, Southampton, 3Southampton Eye Unit, Southampton General Hospital, Southampton, 4NHS Hampshire, Eastleigh, Hampshire, UK

Background: The prevalence of diabetes is increasing worldwide and there is inequality in the distribution of diabetic complications. Diabetic retinopathy is the leading cause of blindness in adults of working age in the UK, and certain risk factors are recognized. Retinopathy screening in the UK involves annual digital retinal photography and image grading. Auditing equity in retinopathy screening poses unique challenges, and screening program data are often incomplete for variables relevant to equity. Using two sources of patient-level primary care data, we conducted a health equity audit comparing the access and uptake of screening between groups of people with diabetes in each of three screening programs covering this area of southern England.
Methods: A patient-level dataset using data from general practices and a combined health record was used to compare dimensions of equity (gender, age, length of time since diabetes diagnosis, type of diabetes, presence of hypertension, socioeconomic deprivation, ethnicity, and screening program) between people with and without a record of retinopathy screening within three years in Hampshire and the Isle of Wight, UK.
Results: Anonymized data for 70,004 people with diabetes were obtained from 205 (88%) general practices. In total, 62,836 people (89.8%) had a record of screening within three years and 7168 (10.2%) did not. Lower uptake of screening was independently associated with the youngest and oldest age groups (compared with 50–79-year-olds), recent diabetes diagnosis, and deprived areas. Diagnosed hypertension was positively associated with screening.
Conclusion: Evaluating equity in screening programs is important to help reduce inequalities. We found evidence of inequity in access and uptake of retinopathy screening. Primary care data contained more information than screening program data. Using a combined health record was more efficient than obtaining data directly from general practices, but data were incomplete for deprivation measures at the time of this audit. Our audit informed subsequent efforts to improve equity in local diabetic retinopathy screening services.

Keywords: inequality, diabetes, eye, complications, screening

Download Article [PDF] 

Creative Commons License This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php

Other article by this author:

Readers of this article also read:

Patient satisfaction with glaucoma therapy: reality or myth?

Lemij HG, Hoevenaars JGMM, van der Windt C, Baudouin C

Clinical Ophthalmology 2015, 9:785-793

Published Date: 4 May 2015

Acute visual loss in a patient with optic disc drusen

Tan DK, Tow SL

Clinical Ophthalmology 2013, 7:795-799

Published Date: 30 April 2013

Sensitivity and specificity of the iVue iWellnessExam™ in detecting retinal and optic nerve disorders

Awad C, Slotnick S, Nath S, Sherman J

Eye and Brain 2013, 5:9-21

Published Date: 14 February 2013

Out-of-office blood pressure: from measurement to control

Baguet JP

Integrated Blood Pressure Control 2012, 5:27-34

Published Date: 16 May 2012

Oral voclosporin: novel calcineurin inhibitor for treatment of noninfectious uveitis

Roesel M, Tappeiner C, Heiligenhaus A, Heinz C

Clinical Ophthalmology 2011, 5:1309-1313

Published Date: 13 September 2011

Soya oil-based shampoo superior to 0.5% permethrin lotion for head louse infestation

Ian F Burgess, Katrina Kay, Nazma A Burgess, et al

Medical Devices: Evidence and Research 2011, 4:35-42

Published Date: 11 March 2011

Seven-year retrospective analysis of the myopic control effect of orthokeratology in children: a pilot study

Alan Kwok-Hei Mok, Cindy Sin-Ting Chung

Clinical Optometry 2011, 3:1-4

Published Date: 1 February 2011

Smart RISUG: A potential new contraceptive and its magnetic field-mediated sperm interaction

Rakhi K Jha, Pradeep K Jha, Sujoy K Guha

International Journal of Nanomedicine 2009, 4:55-64

Published Date: 17 March 2009

Mirror movement associated with neural tube defects

Yasir Andrabi, Farideh Nejat, Mostafa El Khashab, Mohammad Reza Ashrafi

Neuropsychiatric Disease and Treatment 2008, 4:1273-1276

Published Date: 14 September 2008