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. 2023 Nov;11(6):e003683.
doi: 10.1136/bmjdrc-2023-003683.

Ethnic disparities in progression rates for sight-threatening diabetic retinopathy in diabetic eye screening: a population-based retrospective cohort study

Abraham Olvera-Barrios  1   2 , Christopher G Owen  3 , John Anderson  4 , Alasdair N Warwick  5   6 , Ryan Chambers  4 , Louis Bolter  4 , Yue Wu  7   8 , Roshan Welikala  9 , Jiri Fajtl  9 , Sarah A Barman  9 , Paolo Remagnino  10 , Emily Y Chew  11 , Frederick L Ferris  12 , Aroon D Hingorani  6   13 , Reecha Sofat  13 , Aaron Y Lee  7   8 , Catherine Egan  5   2 , Adnan Tufail  5   2 , Alicja R Rudnicka  14 ; ARIAS Research Group
Collaborators, Affiliations

Ethnic disparities in progression rates for sight-threatening diabetic retinopathy in diabetic eye screening: a population-based retrospective cohort study

Abraham Olvera-Barrios et al. BMJ Open Diabetes Res Care. 2023 Nov.

Abstract

Introduction: The English Diabetic Eye Screening Programme (DESP) offers people living with diabetes (PLD) annual eye screening. We examined incidence and determinants of sight-threatening diabetic retinopathy (STDR) in a sociodemographically diverse multi-ethnic population.

Research design and methods: North East London DESP cohort data (January 2012 to December 2021) with 137 591 PLD with no retinopathy, or non-STDR at baseline in one/both eyes, were used to calculate STDR incidence rates by sociodemographic factors, diabetes type, and duration. HR from Cox models examined associations with STDR.

Results: There were 16 388 incident STDR cases over a median of 5.4 years (IQR 2.8-8.2; STDR rate 2.214, 95% CI 2.214 to 2.215 per 100 person-years). People with no retinopathy at baseline had a lower risk of sight-threatening diabetic retinopathy (STDR) compared with those with non-STDR in one eye (HR 3.03, 95% CI 2.91 to 3.15, p<0.001) and both eyes (HR 7.88, 95% CI 7.59 to 8.18, p<0.001). Black and South Asian individuals had higher STDR hazards than white individuals (HR 1.57, 95% CI 1.50 to 1.64 and HR 1.36, 95% CI 1.31 to 1.42, respectively). Additionally, every 5-year increase in age at inclusion was associated with an 8% reduction in STDR hazards (p<0.001).

Conclusions: Ethnic disparities exist in a health system limited by capacity rather than patient economic circumstances. Diabetic retinopathy at first screen is a strong determinant of STDR development. By using basic demographic characteristics, screening programmes or clinical practices can stratify risk for sight-threatening diabetic retinopathy development.

Keywords: blindness; diabetic retinopathy; ethnic groups; healthcare disparities.

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Conflict of interest statement

Competing interests: AYL: has received fees from Santen, Genetech, FDA, Johnson and Johnson, Carl Zeiss Meditec, Gyroscope, Regeneron, and has a non-remunerative relation with Microsoft. CE: has received fees from Heidelberg Engineering, Inozyme Pharma. AT: has received fees from Annexon, Apellis, Bayer, Genentech, Iveric Bio, Novartis, Oxurion, and Roche.

Figures

Figure 1
Figure 1
Survival plots for development of sight-threatening diabetic retinopathy (STDR). Stratified by non-STDR at baseline (no retinopathy, non-STDR in one eye, non-STDR in both eyes) and age (A), and non-STDR at baseline and ethnicity (B). Shaded areas represent 95% CI.
See this image and copyright information in PMC

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