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Prevalence and predictors for being unscreened for diabetic retinopathy: a population-based study over a decade

  • Tina Felfeli
    Correspondence
    Correspondence to Tina Felfeli, MD, Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON M5T 3A9, Canada.
    Affiliations
    Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.

    Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.

    ICES, Toronto, Ont.
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  • Glen Katsnelson
    Affiliations
    Faculty of Medicine, University of Toronto, Toronto, Ont.
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  • Alex Kiss
    Affiliations
    Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.

    ICES, Toronto, Ont.

    Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ont.
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  • Lesley Plumptre
    Affiliations
    ICES, Toronto, Ont.
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  • J. Michael Paterson
    Affiliations
    Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.

    ICES, Toronto, Ont.
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  • Brian G. Ballios
    Affiliations
    Department of Ophthalmology, Toronto Western Hospital, Toronto, Ont.

    Department of Ophthalmology, Sunnybrook Health Sciences Centre, Toronto, Ont.
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  • Efrem D. Mandelcorn
    Affiliations
    Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.

    Department of Ophthalmology, Toronto Western Hospital, Toronto, Ont.
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  • Richard H. Glazier
    Affiliations
    Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.

    ICES, Toronto, Ont.

    MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.

    Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ont.
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  • Michael H. Brent
    Affiliations
    Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.

    Department of Ophthalmology, Toronto Western Hospital, Toronto, Ont.
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  • David T. Wong
    Affiliations
    Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.

    Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.
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      Abstract

      Objective

      To determine the population-level predictors for being unscreened for diabetic retinopathy (DR) among individuals with diabetes in a developed country.

      Design

      A retrospective population-based repeated-cross-sectional study.

      Participants

      All individuals with diabetes (types 1 and 2) aged ≥20 years in the universal health care system in Ontario were identified in the 2011–2013 and 2017–2019 time periods.

      Methods

      The Mantel–Haenszel test was used for the relative risk (RR) comparison of subcategories stratified by the 2 cross-sectional time periods.

      Results

      A total of 1 145 645 and 1 346 578 individuals with diabetes were identified in 2011–2013 and 2017–2019, respectively. The proportion of patients unscreened for DR declined very slightly from 35% (n = 405 967) in 2011–2013 to 34% (n = 455 027) in 2017–2019 of the population with diabetes (RR = 0.967; 95% CI, 0.964–0.9693; p < 0.0001). Young adults aged 20–39 years of age had the highest proportion of unscreened patients (62% and 58% in 2011–2013 and 2017–2019, respectively). Additionally, those who had a lower income quintile (RR = 1.039; 95% CI, 1.036–1.044; p < 0.0001), were recent immigrants (RR = 1.286; 95% CI, 1.280–1.293; p < 0.0001), lived in urban areas (RR = 1.149; 95% CI, 1.145–1.154; p < 0.0001), had a mental health history (RR = 1.117; 95% CI, 1.112–1.122; p < 0.0001), or lacked a connection to a primary care provider (RR = 1.656; 95% CI, 1.644–1.668; p < 0.0001) had a higher risk of being unscreened.

      Conclusions

      This population-based study suggests that over 1 decade, 33% of individuals with diabetes are unscreened for DR, and young age, low income, immigration, residing in a large city, mental health illness, and no primary care access are the main predictors.
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