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Identifying gaps in patient access to diabetic screening eye examinations in Ontario: a provincially representative cross-sectional study

Published:November 21, 2020DOI:https://doi.org/10.1016/j.jcjo.2020.10.018

      Abstract

      Objective

      Diabetes is the leading cause of acquired blindness in Canadians under the age of 50 years, and diabetic retinopathy affects an estimated 500 000 Canadians. Early identification of retinopathy with screening eye examinations allows for secondary prevention. To understand the need for resource allotment in diabetic screening, we undertook a cross-sectional study of key demographics and geographics of screened and unscreened patients in Ontario.

      Methods

      Ontario Health Insurance Plan (OHIP) records were derived from physician and optometry billing, matched with patients aged >19 years with prevalent diabetes between 2011 and 2013. Data were cross-correlated with demographic covariates, including age, sex, income quintile, immigrant status, as well as geographic covariates such as rurality and patient Local Health Integration Network (LHIN).

      Results

      Of almost 1 146 000 patients included in the analysis, approximately 406 000 were unscreened. Of note, this included 234 000 adults aged 40–64 years. Approximately 818 000 patients with diabetes lived in large cities, and 301 000 (37%) were unscreened. When the City of Toronto was analyzed as an urban area with the highest density of unscreened prevalence, autocorrelation between the percentage of eye examinations among patients with diabetes aged >40 years and low-income revealed that large areas of Toronto Central correlated for low examination rates and low income. The majority (13/22) of Community Health Centres are present in these areas.

      Conclusions

      Large cross-sectional population statistics for diabetes prevalence and ophthalmic examinations provides a geographic and socioeconomic profile for populations of middle-aged adults in large urban areas at risk for developing diabetic retinopathy and who might benefit from interventions to improve the rates of screening eye examinations.

      Objectif

      Le diabète est la cause principale de cécité acquise chez les Canadiens de moins de 50 ans; de même, la rétinopathie diabétique touche quelque 500 000 Canadiens. La prévention secondaire dépend du diagnostic précoce de la rétinopathie grâce à la tenue d'examens oculaires. Afin de mieux cerner les besoins en matière d'affectation des ressources dans le dépistage du diabète, nous avons réalisé une étude transversale sur les caractéristiques démographiques et géographiques clés des patients qui ont – ou qui n'ont pas – fait l'objet d'un dépistage en Ontario.

      Méthodes

      Les données de l'Assurance-santé de l'Ontario – issues de la facturation des médecins et des optométristes – ont été appariées avec les patients de > 19 ans qui présentaient un diabète entre 2011 et 2013. On a procédé à une corrélation croisée entre les données ainsi obtenues et les covariables démographiques, dont l’âge, le sexe, le quintile de revenu et le statut d'immigrant, d'une part, et les covariables géographiques, dont la ruralité et le Réseau local d'intégration des services de santé (RLISS) du patient, d'autre part.

      Résultats

      Sur les quelque 1 146 000 patients inclus dans notre analyse, environ 406 000 patients n'ont fait l'objet d'aucun dépistage, dont 234 000 adultes de 40 à 64 ans. Environ 818 000 patients diabétiques vivaient dans de grands centres urbains, et 301 000 (37 %) d'entre eux n'ont fait l'objet d'aucun dépistage. La ville de Toronto a été identifiée en tant que zone urbaine qui présentait la plus forte densité de prévalence non dépistée; lorsqu'on a procédé à une autocorrélation entre le pourcentage d'examens oculaires chez les patients diabétiques de plus de 40 ans et un faible revenu, on a constaté une corrélation entre un faible taux d'examen et un faible revenu dans de vastes zones du Centre-Toronto. La majorité (13/22) des centres de santé communautaire figurent dans ces zones.

      Conclusions

      D'importantes statistiques populationnelles transversales en matière de prévalence du diabète et d'examens ophtalmologiques permettent de dresser un portrait géographique et socioéconomique des populations d'adultes d’âge moyen vivant dans de grands centres urbains qui sont exposées à un risque de rétinopathie diabétique, et qui pourraient bénéficier d'interventions visant à améliorer le taux d'examens de dépistage oculaire.
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