Association between community outpatient clinic care accessibility and the uptake of diabetic retinopathy screening: A multi-level analysis

Factors Affecting Global Adherence for the Uptake of Diabetic Retinopathy Screening: A Systematic Review and Meta-Analysis

PURPOSE

To evaluate diabetic retinopathy (DR) screening global adherence rate and the association between sociodemographic and clinical variables and adherence rates to DR screening in individuals with diabetes.

DESIGN

Systematic review and meta-analysis.

METHODS

This systematic review was registered with International Prospective Register of Systematic Reviews (ID: CRD42024507035). We conducted a systematic review of relevant literature from inception of databases to February 24, 2024, using electronic databases searches including PubMed, MEDLINE (Ovid), EMBASE, Web of Science, Cochrane CENTRAL, and CDSR and national level DR screening databases through Google searches following PRISMA guidelines. The articles were screened for title and abstract and then for the full-text reports by two independent reviewers and study quality was appraised. Meta-analysis was performed using random effects model to calculate the pooled effects size and 95% confidence interval (CI) of each finding.

RESULTS

Data from a total of 11,383,715 participants from 77 studies and two national websites from 28 countries over five continents were included. Global DR screening adherence rate was 66.9% in high-income countries and 39.3% in low-and-middle-income countries. DR screening adherence rate was lowest in Africa (36.1%) and was highest in Europe (81.3%). Older age (odds ratio [OR] 1.45, 95% CI 1.30-1.62), higher education level (OR = 1.65, 95% CI 1.45-1.78), marriage (OR = 1.42, 95% CI 1.14-1.77), living in an urban area (OR = 1.57, 95% CI 1.08-2.29), higher family income (OR = 1.29, 95% CI 1.24-1.35), having any health insurance (OR = 1.90, 95% CI 1.56-2.31), longer duration of diabetes (OR = 1.57, 95% CI 1.27-1.94), type 2 diabetes (OR = 1.68, 95% CI 1.34-2.10), family history of diabetes (OR = 2.25, 95% CI 1.56-3.25), vision impairment (OR = 2.07, 95% CI 1.43-2.98), history of eye diseases (OR = 1.99, 95% CI 1.36-2.90), insulin treatment (OR = 1.38, 95% CI 1.37-1.39), and good mental health (OR = 1.14, 95% CI 1.04-1.24) were associated with DR screening adherence.

CONCLUSION

This meta-analysis provides key information about which population subgroups may require more targeted intervention and highlights the urgent need to identify ways to improve adherence to DR screening.

REGISTRATION INFORMATION

PROSPERO; ref. no. CRD42024507035, (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=507035).

Association between area deprivation index and concerns to COVID-19: A multi-level analysis of individual and area factors

Background

The coronavirus disease 2019 (COVID-19) pandemic has been one of the most serious global threats to public health recently. The present study examined whether area deprivation is associated with concerns related to COVID-19 using large nationwide data across South Korea.

Methods

We used nationwide 2020 Korea Community Health Survey and official government database. Of the 225,680 included participants, 123,324 (54.6%) were women, and the mean age was 54.9 [17.8] years old. We classified the Area deprivation index (ADI) into Quartile 1 (Least deprived); Quartile 2; Quartile 3; and Quartile 4 (Most deprived). Our primary outcome was the concerns related to COVID-19 (0-16 scores). Multilevel regression analysis was conducted.

Results

The mean score of concerns related to COVID-19 was 11.3 [3.2] in the total population. 13.5% of the variability in the scores of concerns related to COVID-19 was accounted for by district areas. Area with Q4 of ADI were associated with an increased score of concerns related to COVID-19 (Q1: reference; Q2: β = 0.218, SE = 0.119, FDR adj.p-value = 0.085; Q3: β = 0.235, SE = 0.133, FDR adj.p-value = 0.094; Q4: β = 0.252, SE = 0.109, FDR adj.p-value = 0.029). 19-49 groups in area with Q4 of ADI were associated with an increase in scores of concerns related to COVID-19 than other age groups in area with Q4 of ADI. Area with Q4 of ADI were associated with a score of concern of being criticized if getting infected compared to area with Q1 of ADI.

Conclusion

We found that the highest quartile ADI was associated with greater concerns related to COVID-19. By identifying vulnerable population to concerns related to COVID-19, health systems may consider preventive intervention to mitigate mental health issues.

Study on Spatial Distribution Equilibrium of Elderly Care Facilities in Downtown Shanghai

With the growing challenge of aging populations around the world, the study of the care services for older adults is an essential initiative to accommodate the particular needs of the disadvantaged communities and promote social equity. Based on open-source data and the geographic information system (GIS), this paper quantifies and visualizes the imbalance in the spatial distribution of elderly care facilities in 14,578 neighborhoods in downtown (seven districts) Shanghai, China. Eight types of elderly care facilities were obtained from Shanghai elderly care service platform, divided into two categories according to their service scale. With the introduction of the improved Gaussian 2-step floating catchment area method, the accessibility of two category facilities was calculated. Through the global autocorrelation analysis, it is found that the accessibility of elderly care facilities has the characteristics of spatial agglomeration. Local autocorrelation analysis indicates the cold and hot spots in the accessibility agglomeration state of the two types of facilities, by which we summarized the characteristics of their spatial heterogeneity. It is found that for Category−I, there is a large range of hot spots in Huangpu District. For Category−II, the hot-spot and cold-spot areas show staggered distribution, and the two categories of hot spot distribution show a negative correlation. We conclude that the two categories are not evenly distributed in the urban area, which will lead to the low efficiency of resource allocation of elderly care facilities and have a negative impact on social fairness. This research offers a systematic method to study urban access to care services for older adults as well as a new perspective on improving social fairness.

Mixed diabetic retinopathy screening coverage results in Indigenous Australian primary care settings: A nurse-led model of integrated diabetes care

AIMS

To determine eye screening coverage and adherence to national eye screening recommendations of a nurse-led retinal image-based model of diabetes education and eye screening in Indigenous primary care clinics.

DESIGN

A pre-post study.

METHODS

During January 2018-March 2020 Indigenous Australians with diabetes at three regional Australian clinics were offered eye screening by a nurse-diabetes educator/retinal imager. At the main site the nurse recruited/scheduled participants, and at satellite sites local clinic staff did so. Visual acuity was tested and digital retinal images acquired and graded. Participants were offered rescreening at or before 12-months based on baseline results.

RESULTS

In total 203 adults with diabetes attending Indigenous primary care clinics were screened, with divergent results based on the recruitment methods. At the main clinic 135 of 172 eligible adults (79%) were screened. At the satellite sites, 15 of 85 (18%) and 21 of 77 (27%) diabetes patients were screened. Combined coverage 51%.

CONCLUSION

A credentialed nurse-educator implemented a model of retinal image-based diabetes education, measured eye screening coverage and adherence to national eye screening guidelines, met the 'acceptable 75% eye screening coverage' benchmark and improved patient eye screening guideline adherence at the one site where the nurse-educator had access to patient recruitment and scheduling.

IMPACT

This novel nurse-led primary care iDEES model of retinal image-based diabetes education can improve the currently low Indigenous diabetes eye screening coverage in Australia. Importantly, the nurse-managed iDEES model of integrated diabetes care is readily adaptable to other settings and populations where access to and/or uptake of eye care is suboptimal.

CLINICAL TRIAL REGISTRATION

ANZCTRN1261800120435.

Association between community deprivation and practising health behaviours among South Korean adults: a survey-based cross-sectional study

OBJECTIVES

This study aimed to determine the association between community deprivation and poor health behaviours among South Korean adults.

DESIGN

This was a survey-based cross-sectional study.

SETTING AND PARTICIPANTS

Data of 224 552 participants from 244 communities were collected from the Korea Community Health Survey, conducted in 2015.

PRIMARY AND SECONDARY OUTCOME MEASURES

We defined health behaviours by combining three variables: not smoking, not high-risk drinking and walking frequently. Community deprivation was classified into social and economic deprivation.

RESULTS

Multilevel logistic analysis was conducted to determine the association of poor health behaviours through a hierarchical model (individual and community) for the 224 552 participants. Among them, 69.9% did not practice healthy behaviours. We found that a higher level of deprivation index was significantly associated with higher odds of not-practising healthy behaviours (Q3, OR: 1.15, 95% CI: 1.00 to 1.31; Q4 (highest), OR: 1.22, 95% CI: 1.06 to 1.39). Economic deprivation had a positive association with not-practising health behaviours while social deprivation had a negative association.

CONCLUSION

These findings imply that community deprivation levels may influence individual health behaviours. Accordingly, there is a need for enforcing the role of primary healthcare centres in encouraging a healthy lifestyle among the residents in their communities, developing national health policy guidelines for health equity and providing financial help to people experiencing community deprivation.

Sex Disparities in Cardiovascular Risk Factor Assessment and Screening for Diabetes-Related Complications in Individuals With Diabetes: A Systematic Review

Background

Insight in sex disparities in the detection of cardiovascular risk factors and diabetes-related complications may improve diabetes care. The aim of this systematic review is to study whether sex disparities exist in the assessment of cardiovascular risk factors and screening for diabetes-related complications.

Methods

PubMed was systematically searched up to April 2020, followed by manual reference screening and citations checks (snowballing) using Google Scholar. Observational studies were included if they reported on the assessment of cardiovascular risk factors (HbA1c, lipids, blood pressure, smoking status, or BMI) and/or screening for nephropathy, retinopathy, or performance of feet examinations, in men and women with diabetes separately. Studies adjusting their analyses for at least age, or when age was considered as a covariable but left out from the final analyses for various reasons (i.e. backward selection), were included for qualitative analyses. No meta-analyses were planned because substantial heterogeneity between studies was expected. A modified Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to assess risk of bias.

Results

Overall, 81 studies were included. The majority of the included studies were from Europe or North America (84%).The number of individuals per study ranged from 200 to 3,135,019 and data were extracted from various data sources in a variety of settings. Screening rates varied considerably across studies. For example, screening rates for retinopathy ranged from 13% to 90%, with half the studies reporting screening rates less than 50%. Mixed findings were found regarding the presence, magnitude, and direction of sex disparities with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, with some evidence suggesting that women, compared with men, may be more likely to receive retinopathy screening and less likely to receive foot exams.

Conclusion

Overall, no consistent pattern favoring men or women was found with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, and screening rates can be improved for both sexes.

Two-Step Floating Catchment Area Model-Based Evaluation of Community Care Facilities' Spatial Accessibility in Xi'an, China

Due to the rapid increase in the number of elderly people in Chinese cities, the development and planning of aged care facilities, and particularly community care facilities, which will gradually become the mainstream choice for the elderly in China, is becoming an important topic for urban sustainability. Previous studies have shown that the number and scale of aged care facilities in many cities are far from meeting the needs of the elderly and the overall occupation rate is low. Some of these cities are still expanding and some are undergoing urban renovation. In this process, the scientific planning of community care facilities to promote efficient use of facility resources has become an urgent problem that needs to be solved. In this study, the two-step floating catchment area (2SFCA) method and a potential model based on the Geographic Information System (GIS) were used to carry out a scientific evaluation of the spatial accessibility of community care facilities in the Beilin district of Xi'an. The aims were to explore the best quantitative research methods for assessing the distribution of Xi'an community care facilities' spatial accessibility, provide ideas for similar studies in the future, and further the understanding of spatial allocation of urban community care facilities resources.