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Mellor J, Jeyam A, Beulens JW, Bhandari S, Broadhead G, Chew E, Fickweiler W, van der Heijden A, Gordin D, Simó R, Snell-Bergeon J, Tynjälä A, Colhoun H. Role of Systemic Factors in Improving the Prognosis of Diabetic Retinal Disease and Predicting Response to Diabetic Retinopathy Treatment. OPHTHALMOLOGY SCIENCE 2024; 4:100494. [PMID: 38694495 PMCID: PMC11061755 DOI: 10.1016/j.xops.2024.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 05/04/2024]
Abstract
Topic To review clinical evidence on systemic factors that might be relevant to update diabetic retinal disease (DRD) staging systems, including prediction of DRD onset, progression, and response to treatment. Clinical relevance Systemic factors may improve new staging systems for DRD to better assess risk of disease worsening and predict response to therapy. Methods The Systemic Health Working Group of the Mary Tyler Moore Vision Initiative reviewed systemic factors individually and in multivariate models for prediction of DRD onset or progression (i.e., prognosis) or response to treatments (prediction). Results There was consistent evidence for associations of longer diabetes duration, higher glycosylated hemoglobin (HbA1c), and male sex with DRD onset and progression. There is strong trial evidence for the effect of reducing HbA1c and reducing DRD progression. There is strong evidence that higher blood pressure (BP) is a risk factor for DRD incidence and for progression. Pregnancy has been consistently reported to be associated with worsening of DRD but recent studies reflecting modern care standards are lacking. In studies examining multivariate prognostic models of DRD onset, HbA1c and diabetes duration were consistently retained as significant predictors of DRD onset. There was evidence of associations of BP and sex with DRD onset. In multivariate prognostic models examining DRD progression, retinal measures were consistently found to be a significant predictor of DRD with little evidence of any useful marginal increment in prognostic information with the inclusion of systemic risk factor data apart from retinal image data in multivariate models. For predicting the impact of treatment, although there are small studies that quantify prognostic information based on imaging data alone or systemic factors alone, there are currently no large studies that quantify marginal prognostic information within a multivariate model, including both imaging and systemic factors. Conclusion With standard imaging techniques and ways of processing images rapidly evolving, an international network of centers is needed to routinely capture systemic health factors simultaneously to retinal images so that gains in prediction increment may be precisely quantified to determine the usefulness of various health factors in the prognosis of DRD and prediction of response to treatment. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Joe Mellor
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Anita Jeyam
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Crewe Road, Edinburgh, Scotland
| | - Joline W.J. Beulens
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Sanjeeb Bhandari
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Geoffrey Broadhead
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Emily Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Ward Fickweiler
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Amber van der Heijden
- Department of General Practice, Amsterdam Public Health Institute, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Department of Nephrology, Helsinki University Hospital, University of Helsinki, Finland
| | - Rafael Simó
- Endocrinology & Nutrition, Institut de Recerca Hospital Universitari Vall d’Hebron (VHIR), Barcelona, Spain
| | - Janet Snell-Bergeon
- Clinical Epidemiology Division, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Colorado
| | - Anniina Tynjälä
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Department of Nephrology, Helsinki University Hospital, University of Helsinki, Finland
| | - Helen Colhoun
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital Crewe Road, Edinburgh, Scotland
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Tan L, Wang J, Han J, Sainsbury C, Denniston AK, Crowe FL, Toulis KA, Karamat MA, Yao M, Nirantharakumar K. Socioeconomic Deprivation and the Risk of Sight-Threatening Diabetic Retinopathy: A Population-Based Cohort Study in the U.K. Diabetes Care 2024; 47:844-848. [PMID: 38387082 DOI: 10.2337/dc23-1626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To evaluate the associations between socioeconomic deprivation and sight-threatening diabetic retinopathy (STDR) in individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Data from 175,628 individuals with diabetes in the Health Improvement Network were used to assess the risk of STDR across Townsend Deprivation Index quantiles using Cox proportional hazard regression. RESULTS Among individuals with T1D, the risk of STDR was three times higher (adjusted hazard ratio [aHR] 2.67, 95% CI 1.05-7.78) in the most deprived quintile compared with the least deprived quintile. In T2D, the most deprived quintile had a 28% higher risk (aHR 1.28; 95% CI 1.15-1.43) than the least deprived quintile. CONCLUSIONS Increasing socioeconomic deprivation is associated with a higher risk of developing STDR in people with diabetes. This underscores persistent health disparities linked to poverty, even within a country offering free universal health care. Further research is needed to address health equity concerns in socioeconomically deprived regions.
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Affiliation(s)
- Luyuan Tan
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Jingya Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Jieun Han
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | | | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
- National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham, U.K
| | - Francesca L Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | | | - Muhammad Ali Karamat
- Diabetes and Endocrinology Specialist Training Committee, Health Education West Midlands, Birmingham, U.K
| | - Mi Yao
- Department of General Practice, Peking University First Hospital, Beijing, China
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Meunier A, Opeifa O, Longworth L, Cox O, Bührer C, Durand-Zaleski I, Kelly SP, Gale RP. An eye on equity: faricimab-driven health equity improvements in diabetic macular oedema using a distributional cost-effectiveness analysis from a UK societal perspective. Eye (Lond) 2024:10.1038/s41433-024-03043-y. [PMID: 38555401 DOI: 10.1038/s41433-024-03043-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/26/2024] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND/OBJECTIVES Diabetic macular oedema (DMO) is a leading cause of blindness in developed countries, with significant disease burden associated with socio-economic deprivation. Distributional cost-effectiveness analysis (DCEA) allows evaluation of health equity impacts of interventions, estimation of how health outcomes and costs are distributed in the population, and assessments of potential trade-offs between health maximisation and equity. We conducted an aggregate DCEA to determine the equity impact of faricimab. METHODS Data on health outcomes and costs were derived from a cost-effectiveness model of faricimab compared with ranibizumab, aflibercept and off-label bevacizumab using a societal perspective in the base case and a healthcare payer perspective in scenario analysis. Health gains and health opportunity costs were distributed across socio-economic subgroups. Health and equity impacts, measured using the Atkinson inequality index, were assessed visually on an equity-efficiency impact plane and combined into a measure of societal welfare. RESULTS At an opportunity cost threshold of £20,000/quality-adjusted life year (QALY), faricimab displayed an increase in net health benefits against all comparators and was found to improve equity. The equity impact increased the greater the concerns for reducing health inequalities over maximising population health. Using a healthcare payer perspective, faricimab was equity improving in most scenarios. CONCLUSIONS Long-acting therapies with fewer injections, such as faricimab, may reduce costs, improve health outcomes and increase health equity. Extended economic evaluation frameworks capturing additional value elements, such as DCEA, enable a more comprehensive valuation of interventions, which is of relevance to decision-makers, healthcare professionals and patients.
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Affiliation(s)
| | | | | | - Oliver Cox
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse, Basel, Switzerland
| | | | | | | | - Richard P Gale
- Hull York Medical School, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
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Rajeswaren V, Lu V, Chen H, Patnaik JL, Manoharan N. Healthcare Resource Utilization and Costs in an At-Risk Population With Diabetic Retinopathy. Transl Vis Sci Technol 2024; 13:12. [PMID: 38359018 PMCID: PMC10876016 DOI: 10.1167/tvst.13.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024] Open
Abstract
Purpose Several investigators have suggested the cost-effectiveness of earlier screening, management of risk factors, and early treatment for diabetic retinopathy (DR). We aimed to evaluate the extent of health care utilization and cost of delayed care by insurance type in a vulnerable patient population. Methods A retrospective analysis of patients with DR was conducted using electronic medical record (EMR) data from January 2014 to December 2020 at Denver Health Medical Center, a safety net institution. Patients were classified by disease severity and insurance status. DR-specific costs were assessed via Current Procedural Terminology (CPT) codes over a 24-month follow-up period. Results Among the 313 patients, a higher proportion of non-English speaking patients were uninsured. Rates of proliferative DR at presentation differed across insurance groups (62% of uninsured, 42% of discount plan, and 33% of Medicare/Medicaid, P = 0.016). There was a significant difference in the total median cost between discount plan patients ($1258, interquartile range [IQR] = $0 - $5901) and both Medicare patients ($751, IQR = $0, $7148, P = 0.037) and Medicaid patients ($593, IQR = $0 - $6299, P = 0.025). Conclusions There were higher rates of proliferative DR at presentation among the uninsured and discount plan patients and greater total median cost in discount plan patients compared to Medicare or Medicaid. These findings prioritize mitigating gaps in insurance coverage and barriers to preventative care among vulnerable populations. Translational Relevance Advanced diabetic disease and increased downstream health care utilization and cost vary across insurance type, suggesting improved access to preventative care is needed in these specific at-risk populations.
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Affiliation(s)
- Vivian Rajeswaren
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Vivian Lu
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hongan Chen
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer L. Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Niranjan Manoharan
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
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Sebastian-Valles F, Martínez-Alfonso J, Arranz Martin JA, Jiménez-Díaz J, Hernando Alday I, Navas-Moreno V, Joya TA, Fandiño García MDM, Román Gómez GL, Garai Hierro J, Lander Lobariñas LE, Martínez de Icaya P, Sampedro-Nuñez MA, Martínez-Vizcaíno V, Marazuela M. Impact of socioeconomic status on chronic control and complications of type 1 diabetes mellitus in users of glucose flash systems: a follow-up study. BMC Med 2024; 22:37. [PMID: 38273326 PMCID: PMC10809494 DOI: 10.1186/s12916-024-03254-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND This study investigates the association between socioeconomic status (SES) and glycemic control in individuals with type 1 diabetes (T1D) using flash glucose monitoring (FGM) devices within a public health system where these technologies are freely available and utilized according to recommended guidelines. METHODS A follow-up study of 1060 adults (mean age 47.4 ± 15.0 years, 49.0% women) with T1D, receiving care at three Spanish university hospitals that regularly employ the FGM system. SES was assessed using the Spanish Deprivation Index and the average annual net income per person. Glycemic data were collected over a 14-day follow-up period, including baseline glycated hemoglobin (HbA1c) levels prior to sensor placement, the last available HbA1c levels, and FGM-derived glucose metrics. Individuals with sensor usage time < 70% were excluded. Chronic micro and macrovascular complications related to diabetes were documented. Regression models, adjusted for clinical variables, were employed to determine the impact of SES on optimal sensor control (defined as time in range (TIR) ≥ 70% with time below range < 4%) and disease complications. RESULTS The average follow-up was of 2 years. The mean TIR and the percentage of individuals with optimal control were higher in individuals in the highest SES quartile (64.9% ± 17.8% and 27.9%, respectively) compared to those in the lowest SES quartile (57.8 ± 17.4% and 12.1%) (p < 0.001). Regression models showed a higher risk of suboptimal control (OR 2.27, p < 0.001) and ischemic heart disease and/or stroke (OR 3.59, p = 0.005) in the lowest SES quartile. No association was observed between SES and the risk of diabetic nephropathy and retinopathy. FGM system improved HbA1c levels across all SES quartiles. Although individuals in the highest SES quartile still achieved a significantly lower value at the end of the follow-up 55 mmol/mol (7.2%) compared to those in the lowest SES quartile 60 mmol/mol (7.6%) (p < 0.001), the significant disparities in this parameter between the various SES groups were significantly reduced after FGM technology use. CONCLUSIONS Socioeconomic status plays a significant role in glycemic control and complications in individuals with T1D, extending beyond access to technology and its proper utilization. The free utilization of FGM technology helps alleviate the impact of social inequalities on glycemic control.
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Affiliation(s)
- Fernando Sebastian-Valles
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain.
| | - Julia Martínez-Alfonso
- Department of Family and Community Medicine, Centro de Salud Daroca, 28006, Madrid, Spain
| | - Jose Alfonso Arranz Martin
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Jessica Jiménez-Díaz
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, Leganés, 28194, Madrid, Spain
| | - Iñigo Hernando Alday
- Department of Endocrinology and Nutrition, Hospital Universitario Basurto, 48013, Bilbao, Spain
| | - Victor Navas-Moreno
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Teresa Armenta Joya
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | | | - Gisela Liz Román Gómez
- Department of Endocrinology and Nutrition, Hospital Universitario Severo Ochoa, Leganés, 28194, Madrid, Spain
| | - Jon Garai Hierro
- Department of Endocrinology and Nutrition, Hospital Universitario Basurto, 48013, Bilbao, Spain
| | | | | | - Miguel Antonio Sampedro-Nuñez
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071, Cuenca, Spain
- Facultad de Ciencias de La Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
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Rao B, Januszewski AS, Brazionis L, O'Connell R, Aryal N, Shimmin G, O'Day J, Mitchell P, Colman PG, Keech AC, Jenkins AJ. No relationship between socioeconomic status, education level and development and progression of diabetic retinopathy in type 2 diabetes: a FIELD trial substudy. Intern Med J 2023; 53:2128-2131. [PMID: 37997276 DOI: 10.1111/imj.16270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/16/2023] [Indexed: 11/25/2023]
Abstract
In 6002 Australian adults with type 2 diabetes and a median 5-year follow-up in the FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) trial, baseline socioeconomic status (SES) and self-reported education level were not related to development of on-trial sight-threatening diabetic retinopathy. Similarly, in a retinal photography substudy (n = 549), two-step diabetic retinopathy progression was not related to SES or education.
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Affiliation(s)
- Ben Rao
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrzej S Januszewski
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Laima Brazionis
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel O'Connell
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nanda Aryal
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Georgia Shimmin
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Justin O'Day
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Mitchell
- The Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Peter G Colman
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Lu VI, Patnaik JL, Scott RA, Lynch AM, Smith JM, Mandava N, Manoharan N. Risk Factors and Outcomes of Delayed Presentation of Diabetic Retinopathy Patients to a County Hospital. Transl Vis Sci Technol 2023; 12:8. [PMID: 37676677 PMCID: PMC10494984 DOI: 10.1167/tvst.12.9.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
Purpose To identify risk factors and evaluate outcomes of patients with delayed presentation and advanced diabetic retinopathy in our safety-net county hospital population. Methods A retrospective study was performed on 562 patients who presented with a new diagnosis of diabetic retinopathy (DR). Delayed presentation was defined as moderate or severe nonproliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) at the initial visit. Comparisons between patient groups were performed with chi-square or Fisher's exact test for categorical variables and multinomial logistic regression for multivariable analysis. Linear and logistic regression modeling with general estimating equations to account for patients having two eyes was used to compare eye-level outcomes. Results Lack of a primary care provider (PCP) was highest in patients who presented initially with PDR (28.8%), compared to 14.3% in moderate/severe NPDR, 12.4% in mild NPDR, and 7.6% in no DR groups (P < 0.001). Only 69.4% of patients with a PCP had an ophthalmology screening referral. Highest lack of referral (47.2%) was seen in the PDR group (P = 0.002). Patients with PDR were more likely to be uninsured (19.2%) compared to no and mild DR groups, with rates of 7.6% and 9.0%, respectively (P = 0.001). The PDR group had worse initial and final visual acuities (P < 0.001). Conclusions Several risk factors were noted for delayed DR presentation, including lack of PCP, lack of screening referral, and uninsured/underinsured status. Patients with advanced DR at presentation had worse final visual outcomes despite aggressive treatment. Translational Relevance Screening programs targeting populations with identified risk factors are essential for improving outcomes.
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Affiliation(s)
- Vivian I. Lu
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer L. Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel A. Scott
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne M. Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jesse M. Smith
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Niranjan Manoharan
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
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8
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Komura T, Kondo N, Bhatt K, Inoue K. Association Between Educational Status and Mortality According to Diabetes Status Among US Adults. Mayo Clin Proc Innov Qual Outcomes 2023; 7:203-211. [PMID: 37304061 PMCID: PMC10250573 DOI: 10.1016/j.mayocpiqo.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Objective To examine differences in the association between educational attainment and mortality by the presence of diabetes and diabetic retinopathy (DR)-a major complication of diabetes. Patients and Methods We used a nationally representative sample of 54,924 US adults aged 20 years or older with diabetes from the National Health and Nutrition Examination Survey 1999-2018 and its mortality data through 2019. We applied the multivariable Cox proportional hazard models to investigate the associations between educational attainment (low, less than high school; middle, high school; and high, more than high school) and all-cause mortality according to diabetes status: nondiabetes, diabetes without DR, and diabetes with DR. Differences in the survival rate by educational attainment were evaluated using the slope inequality index (SII). Results Among the 54,924 participants (mean age, 49.9 years), adults in the low educational group reported an increased risk of all-cause mortality compared with those of the high educational group in any diabetes status (nondiabetes-hazard ratio [HR], 1.69; 95% CI, 1.56-1.82; diabetes without DR-HR, 1.61; 95% CI, 1.37-1.90; diabetes with DR-HR, 1.43; 95% CI, 1.10-1.86). SIIs among the diabetes without DR group and diabetes with DR group were 22.17 and 20.87 per 1000 person-years, respectively, which were 2 times greater than those among the nondiabetes group (SII=9.94). Conclusion The differences in the mortality risks owing to the educational attainment increased by the presence of diabetes regardless of the complication of DR. Our findings indicate that prevention of diabetes itself is critical to mitigate health disparities by socioeconomic status such as education status.
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Affiliation(s)
- Toshiaki Komura
- Department of Epidemiology, Boston University School of Public Health, MA
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Japan
- Department of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Karan Bhatt
- Department of Medicine, UCLA, Los Angeles, CA
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Japan
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Woldetensaye AG, Selander JM, Huang H, Patel PV, Villarreal A, Hesse RA, Greven MA. The Impact of Social Determinants of Health on Presentation, Treatment, and Outcomes in Branch Retinal Vein Occlusion With Cystoid Macular Edema. Ophthalmic Surg Lasers Imaging Retina 2023:1-6. [PMID: 37418672 DOI: 10.3928/23258160-20230616-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
BACKGROUND AND OBJECTIVE To investigate the impact of social determinants of health on the presentation, treatment, and outcomes of branch retinal vein occlusion (BRVO) with cystoid macular edema (CME). PATIENTS AND METHODS A retrospective chart review was conducted of patients with BRVO and CME treated with anti-vascular endothelial growth factor (anti-VEGF) injections at Atrium Health Wake Forest Baptist from 2013 to 2021. Patients' baseline characteristics including visual acuity (VA), age, sex, race, Area Deprivation Index (ADI), insurance status, baseline central macular thickness (CMT), treatment details, final VA, and final CMT were recorded. The primary outcome measure was final VA comparing more and less deprived groups, and White and non-White groups. RESULTS Two hundred forty-four eyes of 240 patients were included. Patients with higher socioeconomic deprivation scores had thicker final CMT (P = 0.05). Non-White patients had worse presenting (P = 0.01) and final VA (P = 0.02). CONCLUSION This study demonstrated disparities in presentation and outcomes based on socioeconomic status and race in patients with BRVO and CME treated with anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina 2023;54:xx-xx.].
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Kilvert A, Fox C. Health inequalities and diabetes. PRACTICAL DIABETES 2023. [DOI: 10.1002/pdi.2435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Charles Fox
- Honorary Lecturer, Leicester Diabetes Centre Leicester UK
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11
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Fallon C, Jones E, Oliver N, Reddy M, Avari P. The impact of socio-economic deprivation on access to diabetes technology in adults with type 1 diabetes. Diabet Med 2022; 39:e14906. [PMID: 35751860 PMCID: PMC9544624 DOI: 10.1111/dme.14906] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/23/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND With advances in technology, there is an emerging concern that inequalities exist in provision and diabetes outcomes in areas of greater deprivation. We assess the relationship between socio-economic status and deprivation with access to diabetes technology and their outcomes in adults with type 1 diabetes. METHODS Retrospective, observational analysis of adults attending a tertiary centre, comprising three urban hospitals in the UK. Socio-economic deprivation was assessed by the English Indices of Deprivation 2019. Data analysis was performed using one-way ANOVAs and chi-squared tests. RESULTS In total, 1631 adults aged 44 ± 15 years and 758 (47%) women were included, with 391 (24%) using continuous subcutaneous insulin infusion, 312 (19%) using real-time continuous glucose monitoring and 558 (34%) using intermittently scanned continuous glucose monitoring. The highest use of diabetes technology was in the least deprived quintile compared to the most deprived quintile (67% vs. 45%, respectively; p < 0.001). HbA1c outcomes were available in 400 participants; no association with deprivation was observed (p = 0.872). Participation in structured education was almost twice as high from the most deprived to the least deprived groups (23% vs. 43%; p < 0.001). Adults with white or mixed ethnicity were more likely to use technology compared to black ethnicity (60% vs. 40%; p < 0.001). CONCLUSIONS Adults living in the most deprived quintile had less technology use. Irrespective of socio-economic status or ethnicity, glycaemia was positively affected in all groups. It is imperative that health disparities are further addressed.
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Affiliation(s)
- Ciara Fallon
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Emma Jones
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Nick Oliver
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Monika Reddy
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and EndocrinologyImperial College Healthcare NHS TrustLondonUK
| | - Parizad Avari
- Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- Department of Diabetes and EndocrinologyImperial College Healthcare NHS TrustLondonUK
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12
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The Comprehensive Effect of Socioeconomic Deprivation on Smoking Behavior: an Observational and Genome-Wide by Environment Interaction Analyses in UK Biobank. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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Kozioł M, Nowak MS, Koń B, Udziela M, Szaflik JP. Regional analysis of diabetic retinopathy and co-existing social and demographic factors in the overall population of Poland. Arch Med Sci 2022; 18:320-327. [PMID: 35316912 PMCID: PMC8924831 DOI: 10.5114/aoms/131264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/07/2020] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The aim of our study was to analyse the regional differences in diabetic retinopathy (DR) prevalence and its co-existing social and demographic factors in the overall population of Poland in the year 2017. MATERIAL AND METHODS Data from all levels of healthcare services at public and private institutions recorded in the National Health Fund database were evaluated. International Classification of Diseases codes were used to identify patients with type 1 and type 2 diabetes mellitus (DM) and with DR. Moran's I statistics and Spatial Autoregressive (SAR) model allowed us to understand the distribution of DR prevalence and its possible association with environmental and demographic exposures. RESULTS In total, 310,815 individuals with diabetic retinopathy (DR) were diagnosed in the year 2017 in Poland. Of them, 174,384 (56.11%) were women, 221,144 (71.15%) lived in urban areas, and 40,231 (12.94%) and 270,584 (87.06%) had type 1 and type 2 DM, respectively. The analysis of the SAR model showed that the significant factors for the occurrence of DR in particular counties were a higher level of average income and a higher number of ophthalmologic consultations per 10,000 adults. CONCLUSIONS The analyses of social, demographic, and systemic factors co-existing with DR revealed that level of income and access to ophthalmologic and diabetic services are crucial in DR prevalence in Poland.
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Affiliation(s)
| | - Michał S. Nowak
- Provisus Eye Clinic, Czestochowa, Poland
- Saint Family Hospital Medical Center, Lodz, Poland
| | - Beata Koń
- Collegium of Economic Analysis, SGH Warsaw School of Economics, Warsaw, Poland
| | - Monika Udziela
- Department of Ophthalmology, Medical University of Warsaw, Public Ophthalmic Clinical Hospital (SPKSO), Warsaw, Poland
| | - Jacek P. Szaflik
- Department of Ophthalmology, Medical University of Warsaw, Public Ophthalmic Clinical Hospital (SPKSO), Warsaw, Poland
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14
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Letta S, Aga F, Yadeta TA, Geda B, Dessie Y. Poor Self-Care Practices and Being Urban Resident Strongly Predict Chronic Complications Among Patients with Type 2 Diabetes in Eastern Ethiopia: A Hospital-Based Cross-Sectional Study. Diabetes Metab Syndr Obes 2022; 15:2095-2106. [PMID: 35898445 PMCID: PMC9309320 DOI: 10.2147/dmso.s368165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diabetes, together with its complications, has a considerable negative influence on people's quality of life and healthcare delivery and raises diabetic mortality. However, there is limited information about the diabetes-associated chronic complications in the study setting. Therefore, this study aimed to determine the burden and factors related to the chronic complications among patients with type 2 diabetes (T2D) in Eastern Ethiopia. METHODS A hospital-based cross-sectional study was conducted among 879 patients with T2D at two public hospitals in Harar. The data were collected through interviews using a structured questionnaire. Data related to the diagnosis of chronic complications and biochemical tests were extracted from medical records. The outcome variable was the number of chronic complications that happened to the patients. A generalized Poisson regression model with robust variance estimation was used to investigate the association of independent variables with chronic complications. An adjusted prevalence ratio with a 95% CI was reported to show an association using a p-value ≤0.05. RESULTS One or more chronic complications were presented in 43% of T2D (95% CI: 39.65, 46.19). Macrovascular and microvascular complications were found in 27.6% and 23.5% of patients, respectively. Urban residence (APR = 2.64; 95% CI: 1.54, 4.54), low wealth status (APR = 1.80; 95% CI: 1.17, 2.76), diabetes duration ≥5 years (APR = 1.46; 95% CI: 1.05, 2.01), hypertriglyceridemia (APR = 1.48; 95% CI: 1.07, 2.09) and poor self-care practices (APR = 1.62; 95% CI: 1.18, 2.23) were factors significantly associated with the chronic complications. CONCLUSION The burden of chronic complications was high, with nearly half of T2D patients experiencing one or more chronic complications. Almost one in ten patients suffered from multiple chronic complications. The complications were mainly influenced by being urban resident, low wealth status, and poor self-care practices. Therefore, health care providers need to educate patients and promote self-care practices and healthy lifestyles to achieve treatment goals and lower the risk of chronic complications.
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Affiliation(s)
- Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Correspondence: Shiferaw Letta, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Tel +251911771934, Email
| | - Fekadu Aga
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene Campus, Shashamene, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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15
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O'Reilly JE, Jeyam A, Caparrotta TM, Mellor J, Hohn A, McKeigue PM, McGurnaghan SJ, Blackbourn LAK, McCrimmon R, Wild SH, Petrie JR, McKnight JA, Kennon B, Chalmers J, Phillip S, Leese G, Lindsay RS, Sattar N, Gibb FW, Colhoun HM. Rising Rates and Widening Socioeconomic Disparities in Diabetic Ketoacidosis in Type 1 Diabetes in Scotland: A Nationwide Retrospective Cohort Observational Study. Diabetes Care 2021; 44:2010-2017. [PMID: 34244330 DOI: 10.2337/dc21-0689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/28/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Whether advances in the management of type 1 diabetes are reducing rates of diabetic ketoacidosis (DKA) is unclear. We investigated time trends in DKA rates in a national cohort of individuals with type 1 diabetes monitored for 14 years, overall and by socioeconomic characteristics. RESEARCH DESIGN AND METHODS All individuals in Scotland with type 1 diabetes who were alive and at least 1 year old between 1 January 2004 and 31 December 2018 were identified using the national register (N = 37,939). DKA deaths and hospital admissions were obtained through linkage to Scottish national death and morbidity records. Bayesian regression was used to test for DKA time trends and association with risk markers, including socioeconomic deprivation. RESULTS There were 30,427 DKA admissions and 472 DKA deaths observed over 393,223 person-years at risk. DKA event rates increased over the study period (incidence rate ratio [IRR] per year 1.058 [95% credibility interval 1.054-1.061]). Males had lower rates than females (IRR male-to-female 0.814 [0.776-0.855]). DKA incidence rose in all age-groups other than 10- to 19-year-olds, in whom rates were the highest, but fell over the study. There was a large socioeconomic differential (IRR least-to-most deprived quintile 0.446 [0.406-0.490]), which increased during follow-up. Insulin pump use or completion of structured education were associated with lower DKA rates, and antidepressant and methadone prescription were associated with higher DKA rates. CONCLUSIONS DKA incidence has risen since 2004, except in 10- to 19-year-olds. Of particular concern are the strong and widening socioeconomic disparities in DKA outcomes. Efforts to prevent DKA, especially in vulnerable groups, require strengthening.
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Affiliation(s)
- Joseph E O'Reilly
- Institute Of Genetics And Cancer, University of Edinburgh, Edinburgh, U.K.
| | - Anita Jeyam
- Institute Of Genetics And Cancer, University of Edinburgh, Edinburgh, U.K
| | | | - Joseph Mellor
- Usher Institute, University of Edinburgh, Edinburgh, U.K
| | - Andreas Hohn
- Institute Of Genetics And Cancer, University of Edinburgh, Edinburgh, U.K
| | | | | | | | - Rory McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, U.K
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, U.K
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - John A McKnight
- Western General Hospital, National Health Service Lothian, Edinburgh, U.K
| | - Brian Kennon
- Queen Elizabeth University Hospital, Glasgow, U.K
| | | | - Sam Phillip
- Grampian Diabetes Research Unit, Diabetes Centre, Aberdeen Royal Infirmary, Aberdeen, U.K
| | - Graham Leese
- Ninewells Hospital, National Health Service Tayside, Dundee, U.K
| | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Fraser W Gibb
- Royal Infirmary of Edinburgh, National Health Service Lothian, Edinburgh, U.K
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16
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Patient management modifications in cataract surgery candidates following incorporation of routine preoperative macular optical coherence tomography. J Cataract Refract Surg 2021; 47:78-82. [PMID: 32815862 DOI: 10.1097/j.jcrs.0000000000000389] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/26/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess the clinical relevance of routine preoperative spectral-domain optical coherence tomography (SD-OCT) for identifying macular pathologies in patients scheduled for cataract surgery. SETTING Shaare-Zedek Medical Center, Jerusalem, Israel. DESIGN Retrospective case series. METHODS Consecutive patients, 50 years of age and older, scheduled for standard cataract extraction surgery were enrolled from November 2017 to January 2018. All study patients underwent routine SD-OCT scanning before cataract surgery. The scans were reviewed by a retinal specialist for macular pathology and compared with preoperative fundus biomicroscopic examination findings. The incidence of macular pathologies and changes in patient management as a result of the macular SD-OCT findings were assessed. RESULTS Four hundred fifty-three eyes of 453 patients were enrolled in the study; 42 eyes (9.2%) were excluded because of noninterpretable SD-OCT scans attributable to advanced cataract, leaving scans of 411 eyes of 411 patients for study inclusion. Macular pathologies were detected by SD-OCT in 167 eyes (40.6%), including age-related macular degeneration (50%), epiretinal membrane (28.3%), and cystoid macular edema (12.8%). Overall, the management of 107 patients (26.0%) was modified because of macular SD-OCT findings, which were either missed (22.8%) or underestimated (3.2%) by the fundus biomicroscopic examination. Changes in preoperative patient management included altering patient consultation regarding presbyopia correction solutions (73 eyes [17.8%]) and referral to a retinal specialist for consultation (34 eyes [8.3%]). CONCLUSIONS Routine macular SD-OCT scans for cataract surgery candidates helped to identify macular pathologies that might be missed or underestimated by standard fundus biomicroscopic examination. The added information could improve patient management.
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Shah S, Feher M, McGovern A, Sherlock J, Whyte MB, Munro N, Hinton W, Gatenby P, de Lusignan S. Diabetic retinopathy in newly diagnosed Type 2 diabetes mellitus: Prevalence and predictors of progression; a national primary network study. Diabetes Res Clin Pract 2021; 175:108776. [PMID: 33753173 DOI: 10.1016/j.diabres.2021.108776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022]
Abstract
AIMS To determine, inreal-world primary care settings, the prevalence of, and risk factors for, retinopathy atType 2 diabetes mellitus diagnosis and report cumulative incidence and progression of retinopathy seven years after diabetes diagnosis. METHODS Retrospective cohort analysis of people with newly diagnosed Type 2 diabetesrecorded bythe Royal College of General Practitioners Research and Surveillance Centre(between 2005 and 2009, n=11,399).Outcomes included; retinopathy prevalence atdiabetesdiagnosis (baseline) and cumulative incidence or progression of retinopathy at seven years. Retinopathy prevalence was compared with the United Kingdom Prospective Diabetes Study (UKPDS-1998). Factors influencing retinopathy incidence and progression were analysed using logistic regression. RESULTS Baseline retinopathy prevalencewas 18% (n=2,048) versus 37% in UKPDS. At seven years, 11.6% (n=237) of those with baseline retinopathyhad progression of retinopathy. In those without baseline retinopathy, 46.4% (n=4,337/9,351) developed retinopathy by seven years. Retinopathy development (OR: 1.05 [95%CI: 1.02-1.07] per mmol/mol increase) and progression (OR: 1.05 [1.04-1.06]) at seven years was associated with higher HbA1catdiabetesdiagnosis. Obesity (OR: 0.88 [0.79-0.98]) and high socioeconomic status (OR: 0.63 [0.53-0.74]) were negatively associated with retinopathy development at seven years. CONCLUSIONS Baseline retinopathy prevalence has declined since UKPDS. Additionally, HbA1c at diabetes diagnosis remains important for retinopathy development and progression.
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Affiliation(s)
- Savan Shah
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK.
| | - Michael Feher
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK; Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, University of Oxford, Oxford OX2 6GG, UK
| | - Andrew McGovern
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK; University of Exeter Medical School, The Institute of Clinical and Biological Sciences, RILD Building, RD&E Hospital, Wonford, Barrack Road, Exeter EX2 5DW, UK
| | - Julian Sherlock
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK
| | - Martin B Whyte
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK
| | - Neil Munro
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK; Diabetes Centre, Dumfries & Galloway Royal Infirmary, A75, Cargenbridge, Dumfries DG2 8RX, UK
| | - William Hinton
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK; Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, University of Oxford, Oxford OX2 6GG, UK
| | - Piers Gatenby
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, School of Biosciences and Medicine, University of Surrey, Guildford GU2 7XH, UK; Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, University of Oxford, Oxford OX2 6GG, UK
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Silverberg EL, Sterling TW, Williams TH, Castro G, Rodriguez de la Vega P, Barengo NC. The Association between Social Determinants of Health and Self-Reported Diabetic Retinopathy: An Exploratory Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020792. [PMID: 33477729 PMCID: PMC7832397 DOI: 10.3390/ijerph18020792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/19/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Abstract
One-third of Americans with diabetes will develop diabetic retinopathy (DR), the leading cause of blindness in working-age Americans. Social determinants of health (SDOHs) are conditions in a person’s environment that may impact health. The objective of this study was to determine whether there is an association between SDOHs and DR in patients with type II diabetes. This cross-section study used data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). This study included people with self-reported diabetes in the US in 2018 (n = 60,703). Exposure variables included homeownership, marital status, income, health care coverage, completed level of education, and urban vs. rural environment. The outcome variable was DR. Logistic regression analysis were applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Alaskan Native/Native American (OR 2.11; 95% CI: 1.14–3.90), out of work (OR 2.82; 95% CI: 1.62–4.92), unable to work (OR 2.14; 95% CI: 1.57–2.91), did not graduate high school (OR 1.91; 95% CI: 1.30–2.79), only graduated high school (OR 1.43; 95% CI 1.08–1.97), or only attended college or technical school without graduating (OR 1.42; 95% CI: 1.09–1.86) were SDOHs associated with DR in patients with diabetes. Health care providers should identify these possible SDOHs affecting their diabetic patients.
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Affiliation(s)
- Emily L. Silverberg
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (E.L.S.); (T.W.S.); (T.H.W.); (G.C.); (P.R.d.l.V.)
| | - Trevor W. Sterling
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (E.L.S.); (T.W.S.); (T.H.W.); (G.C.); (P.R.d.l.V.)
| | - Tyler H. Williams
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (E.L.S.); (T.W.S.); (T.H.W.); (G.C.); (P.R.d.l.V.)
| | - Grettel Castro
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (E.L.S.); (T.W.S.); (T.H.W.); (G.C.); (P.R.d.l.V.)
| | - Pura Rodriguez de la Vega
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (E.L.S.); (T.W.S.); (T.H.W.); (G.C.); (P.R.d.l.V.)
| | - Noël C. Barengo
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (E.L.S.); (T.W.S.); (T.H.W.); (G.C.); (P.R.d.l.V.)
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00100 Helsinki, Finland
- Department of Epidemiology and Public Health, College of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Correspondence: ; Tel.: +1-305-842-8793
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Alvarez-Ramos P, Jimenez-Carmona S, Alemany-Marquez P, Cordoba-Doña JA, Aguilar-Diosdado M. Socioeconomic deprivation and development of diabetic retinopathy in patients with type 1 diabetes mellitus. BMJ Open Diabetes Res Care 2020; 8:e001387. [PMID: 33177040 PMCID: PMC7661358 DOI: 10.1136/bmjdrc-2020-001387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/24/2020] [Accepted: 09/05/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Very little is known about the influence of socioeconomic status on type 1 diabetes mellitus (T1DM) complications. Our aim was to determine whether socioeconomic level is a risk factor for the development of diabetic retinopathy (DR) in patients with T1DM. RESEARCH DESIGN AND METHODS A cohort of 150 patients with T1DM were studied prospectively over 9 years. Socioeconomic status was assessed using a neighborhood-level measure based on an index of deprivation. The contribution of other variables such as hypertension, dyslipidemia, diabetic nephropathy and smoking habit was evaluated. Cox proportional hazards models were used to quantify the associations. RESULTS The incidence of DR was 21.6 cases per 1000 patient-years. Multivariable analyses showed that for each percentage point increase in glycated hemoglobin (HbA1c), the risk of developing DR increased by 58% (HR 1.58, 95% CI 1.19 to 2.10).Patients with T1DM onset >18 years of age and resident in areas of lower socioeconomic levels presented with almost triple the risk of developing DR (HR 2.95, 95% CI 1.08 to 8.00) compared with those with onset <18 years of age and resident in less deprived areas. We did not find significant relationships with other variables studied such as hypertension, dyslipidemia, diabetic nephropathy and smoking habit. CONCLUSIONS Low socioeconomic level is a risk factor, independent of glycemic control, in the development of DR in patients with T1DM when the onset of diabetes is in adulthood. This finding indicates that socioeconomic status and age of onset need to be considered in population screening for DR in patients with T1DM.
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Affiliation(s)
- Pablo Alvarez-Ramos
- Ophtalmology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Soledad Jimenez-Carmona
- Ophtalmology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
- Surgery Department, Universidad de Cádiz Facultad de Medicina, Cadiz, Spain
- Research Institute of Biomedicine of Cadiz (INiBICA), Cadiz, Spain
| | - Pedro Alemany-Marquez
- Ophtalmology Department, Hospital Universitario Puerta del Mar, Cadiz, Spain
- Surgery Department, Universidad de Cádiz Facultad de Medicina, Cadiz, Spain
- Research Institute of Biomedicine of Cadiz (INiBICA), Cadiz, Spain
| | - Juan Antonio Cordoba-Doña
- Research Institute of Biomedicine of Cadiz (INiBICA), Cadiz, Spain
- Public Health Department, Hospital Universitario de Jerez de la Frontera, Jerez de la Frontera, Spain
| | - Manuel Aguilar-Diosdado
- Research Institute of Biomedicine of Cadiz (INiBICA), Cadiz, Spain
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, Universidad de Cadiz, Cadiz, Spain
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Kozioł M, Nowak MS, Udziela M, Piątkiewicz P, Grabska-Liberek I, Szaflik JP. First nation-wide study of diabetic retinopathy in Poland in the years 2013-2017. Acta Diabetol 2020; 57:1255-1264. [PMID: 32500357 PMCID: PMC7495995 DOI: 10.1007/s00592-020-01540-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/23/2020] [Indexed: 12/18/2022]
Abstract
AIMS To assess the prevalence and time trends of diabetic retinopathy (DR) in the overall population of Poland from 2013 to 2017 and diagnose the risk factors of occurring DR among patients with diabetes mellitus (DM). METHODS Data from all levels of healthcare services at public and private institutions recorded in the National Health Fund (NHF) database were evaluated. International Classification of Diseases codes (ICD-9 and ICD-10) and unique NHF codes were used to identify DM type 1 and type 2 patients, DR and treatment procedures including laser photocoagulation, pars plana vitrectomy (PPV), anti-VEGF and steroid intravitreal injections. RESULTS The overall registered prevalence of DR in the entire population of Poland was 0.81%. The mean prevalence of DR was 20.01% in the population with type 1 DM and 9.70% in the population with type 2 DM. In the study period, women represented 56.36% of all individuals registered with DR and 55.09% of all DM patients. In Poland, only 6.34% of all DM patients with DR received specific treatment with laser photocoagulation of the retina (82.32%), PPV (11.56%), anti-VEGF or steroid injections (5.15% and 0.97%, respectively). Cox regression hazard analysis showed that the risk of DR was associated with DM treatment only by GPs, female sex, coexisting systemic diseases and urban residence in both type 1 and type 2 DM. CONCLUSIONS A 5-year retrospective analysis reveals the mean prevalence of DR in the population with type 1 and type 2 DM in Poland was rather low.
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Affiliation(s)
- Milena Kozioł
- Department of Analyses and Strategies, Ministry of Health, 15 Miodowa str., 00-952, Warsaw, Poland
- Department of Ophthalmology, Medical University of Warsaw, Public Ophthalmic Clinical Hospital (SPKSO), 13 Sierakowskiego str., 03-709, Warsaw, Poland
| | - Michał S Nowak
- Provisus Eye Clinic, 112 Redzinska str., 42-209, Czestochowa, Poland.
- Saint Family Hospital Medical Center, 19 Wigury str., 90-302, Lodz, Poland.
| | - Monika Udziela
- Department of Ophthalmology, Medical University of Warsaw, Public Ophthalmic Clinical Hospital (SPKSO), 13 Sierakowskiego str., 03-709, Warsaw, Poland
| | - Paweł Piątkiewicz
- Department of Internal Diseases, Diabetology and Endocrinology, Medical University of Warsaw, 8 Kondratowicza str., 03-242, Warsaw, Poland
| | - Iwona Grabska-Liberek
- Department of Ophthalmology, Centre of Postgraduate Medical Education, 231 Czerniakowska str., 01-416, Warsaw, Poland
| | - Jacek P Szaflik
- Department of Ophthalmology, Medical University of Warsaw, Public Ophthalmic Clinical Hospital (SPKSO), 13 Sierakowskiego str., 03-709, Warsaw, Poland
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Low JR, Gan ATL, Fenwick EK, Gupta P, Wong TY, Teo ZL, Thakur S, Tham YC, Sabanayagam C, Cheng CY, Lamoureux EL, Man REK. Role of socio-economic factors in visual impairment and progression of diabetic retinopathy. Br J Ophthalmol 2020; 105:420-425. [PMID: 32430341 DOI: 10.1136/bjophthalmol-2020-316430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND To investigate the longitudinal associations between person-level and area-level socioeconomic status (PLSES and ALSES, respectively) with diabetic retinopathy (DR) and visual impairment (VI) in Asians with diabetes mellitus (DM). METHODS In this population-based cohort study, we included 468 (39.4%) Malays and 721 (60.6%) Indians with DM, with a mean age (SD) of 58.9 (9.1) years; 50.6% were female and the mean follow-up duration was 6.2 (0.9) years. Individual PLSES parameters (education, monthly income and housing type) were quantified using questionnaires. ALSES was assessed using the Socioeconomic Disadvantage Index derived from Singapore's 2010 areal census (higher scores indicate greater disadvantage). Incident DR and VI were defined as absent at baseline but present at follow-up, while DR and VI progression were defined as a ≥1 step increase in severity category at follow-up. Modified Poisson regression analysis was used to determine the associations of PLSES and ALSES with incidence and progression of DR and VI, adjusting for relevant confounders. RESULTS In multivariable models, per SD increase in ALSES score was associated with greater DR incidence (risk ratio (95% CI) 1.27 (1.13 to 1.44)), DR progression (1.10 (1.00 to 1.20)) and VI incidence (1.10 (1.04 to 1.16)), while lower PLSES variables were associated with increased DR (low income: 1.68 (1.21 to 2.34)) and VI (low income: 1.44 (1.13 to 1.83); ≤4 room housing: 2.00 (1.57 to 2.54)) incidence. CONCLUSIONS We found that both PLSES and ALSES variables were independently associated with DR incidence, progression and associated vision loss in Asians. Novel intervention strategies targeted at low socioeconomic status communities to decrease rates of DR and VI are warranted.
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Affiliation(s)
- Jin Rong Low
- Singapore Eye Research Institute, Singapore Eye Research Institute, Singapore
| | | | - Eva K Fenwick
- Singapore Eye Research Institute, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute, Singapore Eye Research Institute, Singapore
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,National University of Singapore, Singapore
| | - Zhen Ling Teo
- Singapore Eye Research Institute, Singapore Eye Research Institute, Singapore
| | - Sahil Thakur
- Singapore Eye Research Institute, Singapore Eye Research Institute, Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,National University of Singapore, Singapore
| | - Ecosse Luc Lamoureux
- Singapore Eye Research Institute, Singapore Eye Research Institute, Singapore .,Duke-NUS Medical School, Singapore.,National University of Singapore, Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
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22
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Xie L, Yang S, Squirrell D, Vaghefi E. Towards implementation of AI in New Zealand national diabetic screening program: Cloud-based, robust, and bespoke. PLoS One 2020; 15:e0225015. [PMID: 32275656 PMCID: PMC7147747 DOI: 10.1371/journal.pone.0225015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/18/2020] [Indexed: 11/18/2022] Open
Abstract
Convolutional Neural Networks (CNNs) have become a prominent method of AI implementation in medical classification tasks. Grading Diabetic Retinopathy (DR) has been at the forefront of the development of AI for ophthalmology. However, major obstacles remain in the generalization of these CNNs onto real-world DR screening programs. We believe these difficulties are due to use of 1) small training datasets (<5,000 images), 2) private and 'curated' repositories, 3) locally implemented CNN implementation methods, while 4) relying on measured Area Under the Curve (AUC) as the sole measure of CNN performance. To address these issues, the public EyePACS Kaggle Diabetic Retinopathy dataset was uploaded onto Microsoft Azure™ cloud platform. Two CNNs were trained; 1 a "Quality Assurance", and 2. a "Classifier". The Diabetic Retinopathy classifier CNN (DRCNN) performance was then tested both on 'un-curated' as well as the 'curated' test set created by the "Quality Assessment" CNN model. Finally, the sensitivity of the DRCNNs was boosted using two post-training techniques. Our DRCNN proved to be robust, as its performance was similar on 'curated' and 'un-curated' test sets. The implementation of 'cascading thresholds' and 'max margin' techniques led to significant improvements in the DRCNN's sensitivity, while also enhancing the specificity of other grades.
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Affiliation(s)
- Li Xie
- School of Optometry and Vision Sciences, The University of Auckland, Auckland, New Zealand
| | - Song Yang
- School of Optometry and Vision Sciences, The University of Auckland, Auckland, New Zealand
- School of Computer Sciences, The University of Auckland, Auckland, New Zealand
| | - David Squirrell
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Ehsan Vaghefi
- School of Optometry and Vision Sciences, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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23
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Tatulashvili S, Fagherazzi G, Dow C, Cohen R, Fosse S, Bihan H. Socioeconomic inequalities and type 2 diabetes complications: A systematic review. DIABETES & METABOLISM 2019; 46:89-99. [PMID: 31759171 DOI: 10.1016/j.diabet.2019.11.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/19/2019] [Accepted: 11/06/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES A socioeconomic gradient related to type 2 diabetes (T2D) prevalence has been demonstrated in high-income countries. However, there is no evidence of such a socioeconomic gradient regarding diabetes complications. Thus, the aim of this systematic review was to collect data on risk of complications according to socioeconomic status in patients with T2D. METHODS PubMed and EMBASE were searched for English-language observational studies evaluating the prevalence or incidence of micro- and macrovascular complications according to individual and geographical socioeconomic status (SES). Observational studies reporting the prevalence and risk of micro- and macrovascular diabetes complications, according to an individual or geographical index of deprivation, were selected, and estimated crude and adjusted risks for each complication were reported. RESULTS Among the 28 included studies, most described a clear relationship between SES and diabetes complications, especially retinopathy (in 9 of 14 studies) and cardiopathy (in 8 of 9 studies). Both individual and area-based low SES was associated with an increased risk of complications. However, very few studies adjusted their analyses according to HbA1c level. CONCLUSION Evaluation of SES is necessary for every T2D patient, as it appears to be a risk factor for diabetes complications. However, the available studies are insufficient for gradation of the impact of low socioeconomic level on each of these complications. Regardless, strategies for the improved screening, follow-up and care of high-risk patients should now be implemented.
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Affiliation(s)
- S Tatulashvili
- Department of Endocrinology, Diabetology, Metabolic Disease, Avicenne Hospital, Sorbonne Paris Cité, CRNH-IdF, Paris 13 University, AP-HP, 93000 Bobigny, France
| | - G Fagherazzi
- Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), Paris-Sud Paris-Saclay University, 94800 Villejuif, France
| | - C Dow
- Inserm U1018, Centre for Research in Epidemiology and Population Health (CESP), Paris-Sud Paris-Saclay University, 94800 Villejuif, France
| | - R Cohen
- Department of Endocrinology, Diabetology, Delafontaine Hospital, 93205 Saint-Denis, France
| | - S Fosse
- French National Public Health Agency, 94410 Saint-Maurice, France
| | - H Bihan
- Department of Endocrinology, Diabetology, Metabolic Disease, Avicenne Hospital, Sorbonne Paris Cité, CRNH-IdF, Paris 13 University, AP-HP, 93000 Bobigny, France; Health Education and Practice Laboratory, EA 3412, UFR SMBH Léonard de Vinci, Paris 13 University, 93017 Bobigny, France.
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24
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Everett E, Mathioudakis N. Association of Area Deprivation and Diabetic Ketoacidosis Readmissions: Comparative Risk Analysis of Adults vs Children With Type 1 Diabetes. J Clin Endocrinol Metab 2019; 104:3473-3480. [PMID: 31220288 PMCID: PMC6599429 DOI: 10.1210/jc.2018-02232] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/05/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Recurrent diabetic ketoacidosis (DKA) is associated with mortality in adults and children with type 1 diabetes (T1D). We aimed to evaluate the association of area deprivation and other patient factors with recurrent DKA in pediatric patients compared with adults. RESEARCH DESIGN AND METHODS This cross-sectional study used the Maryland Health Services Cost Review Commission's database to identify patients with T1D admitted for DKA between 2012 and 2017. Area deprivation and other variables were obtained from the first DKA admission of the study period. Multivariable logistic regression analysis was performed to determine predictors of DKA readmissions. Interactions (Ints) evaluated differences among the groups. RESULTS There were 732 pediatric and 3305 adult patients admitted with DKA. Area deprivation was associated with higher odds of readmission in pediatric patients than in adults. Compared with the least deprived, moderately deprived pediatric patients had an OR of 7.87-(95% CI, 1.02 to 60.80) compared with no change in odds in adults for four or more readmissions (Pint < 0.01). Similar odds were observed in the most deprived pediatric patients, which differed significantly from the OR of 2.23 (95% CI, 1.16 to 4.25) in adults (Pint of 0.2). Moreover, increasing age, female sex, Hispanic ethnicity, and discharge against medical advice conferred a high odds for four or more readmissions in pediatric patients compared with adults. CONCLUSION Area deprivation was predictive of recurrent DKA admissions, with a more pronounced influence in pediatric than adult patients with T1D. Further studies are needed to understand the mechanisms behind these associations and address disparities specific to each population.
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Affiliation(s)
- Estelle Everett
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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25
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Mair C, Wulaningsih W, Jeyam A, McGurnaghan S, Blackbourn L, Kennon B, Leese G, Lindsay R, McCrimmon RJ, McKnight J, Petrie JR, Sattar N, Wild SH, Conway N, Craigie I, Robertson K, Bath L, McKeigue PM, Colhoun HM. Glycaemic control trends in people with type 1 diabetes in Scotland 2004-2016. Diabetologia 2019; 62:1375-1384. [PMID: 31104095 PMCID: PMC6647722 DOI: 10.1007/s00125-019-4900-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/12/2019] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to examine whether glycaemic control has improved in those with type 1 diabetes in Scotland between 2004 and 2016, and whether any trends differed by sociodemographic factors. METHODS We analysed records from 30,717 people with type 1 diabetes, registered anytime between 2004 and 2016 in the national diabetes database, which contained repeated measures of HbA1c. An additive mixed regression model was used to estimate calendar time and other effects on HbA1c. RESULTS Overall, median (IQR) HbA1c decreased from 72 (21) mmol/mol [8.7 (4.1)%] in 2004 to 68 (21) mmol/mol (8.4 [4.1]%) in 2016. However, all of the improvement across the period occurred in the latter 4 years: the regression model showed that the only period of significant change in HbA1c was 2012-2016 where there was a fall of 3 (95% CI 1.82, 3.43) mmol/mol. The largest reductions in HbA1c in this period were seen in children, from 69 (16) mmol/mol (8.5 [3.6]%) to 63 (14) mmol/mol (7.9 [3.4]%), and adolescents, from 75 (25) mmol/mol (9.0 [4.4]%) to 70 (23) mmol/mol (8.6 [4.3]%). Socioeconomic status (according to Scottish Index of Multiple Deprivation) affected the HbA1c values: from the regression model, the 20% of people living in the most-deprived areas had HbA1c levels on average 8.0 (95% CI 7.4, 8.9) mmol/mol higher than those of the 20% of people living in the least-deprived areas. However this difference did not change significantly over time. From the regression model HbA1c was on average 1.7 (95% CI 1.6, 1.8) mmol/mol higher in women than in men. This sex difference did not narrow over time. CONCLUSIONS/INTERPRETATION In this high-income country, we identified a modest but important improvement in HbA1c since 2012 that was most marked in children and adolescents. These changes coincided with national initiatives to reduce HbA1c including an expansion of pump therapy. However, in most people, overall glycaemic control remains far from target levels and further improvement is badly needed, particularly in those from more-deprived areas.
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Affiliation(s)
- Colette Mair
- MRC Institute of Genetic and Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Wahyu Wulaningsih
- MRC Institute of Genetic and Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Anita Jeyam
- MRC Institute of Genetic and Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Stuart McGurnaghan
- MRC Institute of Genetic and Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Luke Blackbourn
- MRC Institute of Genetic and Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Brian Kennon
- Department of Diabetes, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Graham Leese
- Department of Public Health, NHS Fife, Kirkcaldy, UK
| | - Robert Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Rory J McCrimmon
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - John McKnight
- Metabolic Unit, Western General Hospital, Edinburgh, UK
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sarah H Wild
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Ian Craigie
- GGC Children's Diabetes Service, Glasgow, UK
| | | | - Louise Bath
- NHS Lothian, Royal Hospital for Sick Children, Edinburgh, UK
| | - Paul M McKeigue
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Helen M Colhoun
- MRC Institute of Genetic and Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
- Department of Public Health, NHS Fife, Kirkcaldy, UK.
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26
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Gillis KA, Lees JS, Ralston MR, Glen JA, Stevenson KS, McManus SK, Geddes CC, Clancy M, Traynor JP, Mark PB. Interaction between socioeconomic deprivation and likelihood of pre-emptive transplantation: influence of competing risks and referral characteristics - a retrospective study. Transpl Int 2018; 32:153-162. [DOI: 10.1111/tri.13336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/09/2018] [Accepted: 08/23/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Keith A. Gillis
- Institute of Cardiovascular and Medical Science; University of Glasgow; Glasgow UK
| | - Jennifer S. Lees
- Institute of Cardiovascular and Medical Science; University of Glasgow; Glasgow UK
| | | | - Julie A. Glen
- Glasgow Renal and Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Karen S. Stevenson
- Glasgow Renal and Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Siobhan K. McManus
- Glasgow Renal and Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Colin C. Geddes
- Glasgow Renal and Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Marc Clancy
- Glasgow Renal and Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Jamie P. Traynor
- Glasgow Renal and Transplant Unit; Queen Elizabeth University Hospital; Glasgow UK
| | - Patrick B. Mark
- Institute of Cardiovascular and Medical Science; University of Glasgow; Glasgow UK
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27
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Sim PY, Gajree S, Dhillon B, Borooah S. Investigation of time to first presentation and extrahospital factors in the treatment of neovascular age-related macular degeneration: a retrospective cross-sectional study. BMJ Open 2017; 7:e017771. [PMID: 29229653 PMCID: PMC5778287 DOI: 10.1136/bmjopen-2017-017771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To assess the time from symptom onset to treatment for neovascular age-related macular degeneration (nvAMD) and to measure the awareness of AMD in Southeast Scotland. DESIGN Retrospective cross-sectional study. SETTING Secondary care, Southeast of Scotland. METHODS Patients treated with intravitreal therapy (IVT) for nvAMD in Southeast Scotland between 2013 and 2015 were identified using a treatment register. Notes were retrospectively reviewed. We measured time from: (A) symptom onset to first presentation at primary care, (B) referral to ophthalmic clinic appointment and (C) ophthalmic clinic appointment to first IVT treatment. To investigate AMD awareness, we performed a cluster random sample survey of patients visiting non-AMD ophthalmic clinics using a previously validated 12-item questionnaire. RESULTS 195 patients (mean age 78 years) were included in the study. The mean delays between the different stages-A, B and C-were 54.2 (95% CI ±13), 28.2 (95% CI ±4.0) and 31.5 (95% CI ±3.6) days, respectively. There was an additional mean delay of 7.5 (95% CI ±1.6) days when patients were indirectly referred by optometrists via general practitioners (P<0.05). 140 patients (mean age 78) participated in the awareness survey; 62.1% reported being 'aware' of AMD but only 37.3% described AMD symptoms correctly. CONCLUSIONS There was a significant delay at every step of the nvAMD care pathway. The causes for this were multifactorial and included delays in first presentation to a healthcare provider, referral from primary care and initiation of secondary care treatment. Our data are likely to underestimate prehospital delays as a large number of cases are likely to have undefined symptoms and onset. We also identified suboptimal awareness of AMD which could account for a substantial delay in presentation from symptom onset. These findings highlight the need to address AMD awareness and the need for urgent treatment to prevent avoidable vision loss resulting from nvAMD.
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Affiliation(s)
- Peng Yong Sim
- College of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Sonul Gajree
- Ophthalmology Department, Gartnavel General Hospital, Glasgow, UK
| | - Baljean Dhillon
- College of Medicine & Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
- The Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Shyamanga Borooah
- Moorfields Eye Hospital, London, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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28
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Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives. Surv Ophthalmol 2017; 63:406-436. [PMID: 29100897 DOI: 10.1016/j.survophthal.2017.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.
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29
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Du J, Jin H, Yang L. Role of Hydrogen Sulfide in Retinal Diseases. Front Pharmacol 2017; 8:588. [PMID: 28900398 PMCID: PMC5581915 DOI: 10.3389/fphar.2017.00588] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 08/15/2017] [Indexed: 12/26/2022] Open
Abstract
As the third gasotransmitter, hydrogen sulfide (H2S) plays a crucial role in the physiology and pathophysiology of many systems in the body, such as the nervous, cardiovascular, respiratory, and gastrointestinal systems. The mechanisms for its effects, including inhibiting ischemic injury, reducing oxidative stress damage, regulating apoptosis, and reducing the inflammation reaction in different systems, have not been fully understood. Recently, H2S and its endogenous synthesis pathway were found in the mammalian retina. This review describes the production and the metabolism of H2S and the evidence of a role of H2S in the retina physiology and in the different retinal diseases, including retinal degenerative diseases and vascular diseases. In the retina, H2S is generated in the presence of cystathionine-β-synthase, cystathionine-γ-lyase, and 3-mercaptopyruvate sulfurtransferase from L-cysteine. The role of endogenous H2S and its physiologic effect in the retina are still elusive. However, strong evidence shows that retina-derived H2S might play protective or deleterious role in the pathogenesis of retinal diseases. For example, by regulating Ca2+ influx, H2S can protect retinal neurons against light-induced degeneration. H2S preconditioning can mediate the anti-apoptotic effect of retinal ganglion cells in retinal ischemia/reperfusion injury. Treatment with H2S in rats relieves diabetic retinopathy by suppressing oxidative stress and reducing inflammation. Further studies would greatly improve our understanding of the pathophysiologic mechanisms responsible for retinal diseases and the potential for the H2S-related therapy of the retinal diseases as well.
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Affiliation(s)
- Jiantong Du
- Department of Ophthalmology, Peking University First HospitalBeijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First HospitalBeijing, China
| | - Liu Yang
- Department of Ophthalmology, Peking University First HospitalBeijing, China
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30
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Socioeconomic status and type 2 diabetes complications among young adult patients in Japan. PLoS One 2017; 12:e0176087. [PMID: 28437472 PMCID: PMC5402943 DOI: 10.1371/journal.pone.0176087] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/05/2017] [Indexed: 12/13/2022] Open
Abstract
Objective To assess the relationship between socioeconomic status (SES) and complications of type 2 diabetes among young adults in Japan. Design A cross-sectional study. Setting Outpatient wards of 96 member hospitals and clinics of the Japan Federation of Democratic Medical Institutions. Participants A total of 782 outpatients with type 2 diabetes (525 males, 257 females), aged 20–40 years as of March 31, 2012. After excluding 110 participants whose retinopathy diagnosis was in question, 672 participants were analyzed. Measurements We examined the relations between SES (educational level, income, type of public healthcare insurance, and employment status) and diabetes complications (retinopathy and nephropathy) using a multivariate logistic regression analysis. Results The prevalence of type 2 diabetic retinopathy was 23.2%, while that of nephropathy was 8.9%. The odds of having retinopathy were higher among junior high school graduates (OR 1.91, 95% CI 1.09–3.34), patients receiving public assistance (OR 2.19, 95% CI 1.20–3.95), and patients with irregular (OR 1.72, 95% CI 1.03–2.86) or no employment (OR 2.23, 95% CI 1.36–3.68), compared to those with a higher SES, even after covariate adjustment (e.g., age, gender, body mass index). Similarly, the odds of having nephropathy were higher among patients with middle (OR 3.61, 95% CI 1.69–8.27) or low income levels (OR 2.53, 95% CI 1.11–6.07), even after covariate adjustment. Conclusions Low SES was associated with a greater likelihood of type 2 diabetes complications in young adults. These findings suggest the necessity of health policies that mitigate socioeconomic disparity and thereby reduce the prevalence of diabetic complications.
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31
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Wang SY, Andrews CA, Herman WH, Gardner TW, Stein JD. Incidence and Risk Factors for Developing Diabetic Retinopathy among Youths with Type 1 or Type 2 Diabetes throughout the United States. Ophthalmology 2017; 124:424-430. [PMID: 27914837 PMCID: PMC5728116 DOI: 10.1016/j.ophtha.2016.10.031] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/21/2016] [Accepted: 10/27/2016] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Despite the increasing prevalence of type 2 diabetes mellitus (T2DM) among children and adolescents, little is known about their risk of developing diabetic retinopathy (DR). We sought to identify risk factors for DR in youths with diabetes mellitus, to compare DR rates for youths with type 1 diabetes mellitus (T1DM) and those with T2DM, and to assess whether adherence to DR screening guidelines promoted by the American Academy of Ophthalmology, American Academy of Pediatrics, and American Diabetes Association adequately capture youths with DR. DESIGN Retrospective observational longitudinal cohort study. PARTICIPANTS Youths aged ≤21 years with newly diagnosed T1DM or T2DM who were enrolled in a large US managed-care network. METHODS In this study of youths aged ≤21 years with newly diagnosed T1DM or T2DM who were under ophthalmic surveillance, we identified the incidence and timing of DR onset. Kaplan-Meier survival curves assessed the timing of initial diagnosis of DR for participants. Multivariable Cox proportional hazard regression modeling identified factors associated with the hazard of developing DR. Model predictors were age and calendar year at initial diabetes mellitus diagnosis, sex, race/ethnicity, net worth, and glycated hemoglobin A1c fraction (HbA1c). MAIN OUTCOME MEASURES Hazard ratios (HRs) with 95% confidence intervals (CIs) for developing DR. RESULTS Among the 2240 youths with T1DM and 1768 youths with T2DM, 20.1% and 7.2% developed DR over a median follow-up time of 3.2 and 3.1 years, respectively. Survival curves demonstrated that youths with T1DM developed DR faster than youths with T2DM (P < 0.0001). For every 1-point increase in HbA1c, the hazard for DR increased by 20% (HR = 1.20; 95% CI 1.06-1.35) and 30% (HR = 1.30; 95% CI 1.08-1.56) among youths with T1DM and T2DM, respectively. Current guidelines suggest that ophthalmic screening begin 3 to 5 years after initial diabetes mellitus diagnosis, at which point in our study, >18% of youths with T1DM had already received ≥1 DR diagnosis. CONCLUSIONS Youths with T1DM or T2DM exhibit a considerable risk for DR and should undergo regular screenings by eye-care professionals to ensure timely DR diagnosis and limit progression to vision-threatening disease.
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Affiliation(s)
- Sophia Y Wang
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Chris A Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - William H Herman
- Michigan Diabetes Research Center, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan Medical School, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Joshua D Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan.
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Low L, Hodson J, Morris D, Desai P, MacEwen C. Socioeconomic deprivation and serious ocular trauma in Scotland: a national prospective study. Br J Ophthalmol 2017; 101:1395-1398. [PMID: 28274942 PMCID: PMC5629949 DOI: 10.1136/bjophthalmol-2016-309875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/08/2017] [Accepted: 02/10/2017] [Indexed: 11/17/2022]
Abstract
Objective To identify the population at risk of serious ocular trauma by exploring relationships with socioeconomic factors. Design National, prospective, population-based, cross-sectional and follow-up study. Participants Patients with serious ocular trauma requiring hospital admission in Scotland. Methods Case definition and ascertainment—cases of serious ocular trauma necessitating admission to hospital under the care of a consultant ophthalmologist were identified using the British Ophthalmological Surveillance Unit reporting scheme. Using the postcode of residence, we assigned a Scottish Index of Multiple Deprivation (SIMD) score, SIMD quintile ( 0%–20% most deprived; 20%–40%, 40%–60%, 60%–80%, 80%–100% least deprived areas), geographical access score as well as the estimated travel time to the nearest general practitioner (GP) practice using either car or public transport for each patient. Population estimates were obtained from the General Register Office for Scotland. Main outcome measure Serious ocular trauma requiring hospital admission. Results A total of 104 patients (85.6% male) were reported as being admitted with ocular trauma with a median age of 32 years (IQR 24–54). There was a trend for increasing incidence of serious ocular injury with increasing socioeconomic deprivation (p=0.034). Patients from the most deprived areas (SIMD: 0%–20%) were twice as likely to sustain ocular injury compared with those from the least deprived (SIMD: 80%–100%) areas (relative risk: 2.19, 95% CI 1.02 to 4.81). There was no significant difference in the drive/public transport time to GP practices across the SIMD quintiles. Conclusions Increasing socioeconomic deprivation was associated with a higher incidence of serious ocular injury. Targeted interventions are needed to address inequality in eye healthcare in deprived areas.
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Affiliation(s)
- Liying Low
- Academic Unit of Ophthalmology, University of Birmingham, Birmingham and Midland Eye Centre, Birmingham, UK
| | - James Hodson
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Daniel Morris
- Cardiff Eye Unit, University Hospital of Wales, Cardiff, Wales, UK
| | - Parul Desai
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Caroline MacEwen
- Department of Ophthalmology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
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Mathur R, Bhaskaran K, Edwards E, Lee H, Chaturvedi N, Smeeth L, Douglas I. Population trends in the 10-year incidence and prevalence of diabetic retinopathy in the UK: a cohort study in the Clinical Practice Research Datalink 2004-2014. BMJ Open 2017; 7:e014444. [PMID: 28246144 PMCID: PMC5337737 DOI: 10.1136/bmjopen-2016-014444] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/18/2016] [Accepted: 12/19/2016] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To describe trends in the incidence and prevalence of diabetic retinopathy (DR) in the UK by diabetes type, age, sex, ethnicity, deprivation, region and calendar year. DESIGN Cohort study using the Clinical Practice Research Datalink (CPRD). SETTING UK primary care. PARTICIPANTS 7.7 million patients ≥12 contributing to the CPRD from 2004 to 2014. PRIMARY AND SECONDARY OUTCOME MEASURES Age-standardised prevalence and incidence of diabetes, DR and severe DR (requiring photocoagulation) by calendar year and population subgroup. Relative risk of developing DR and severe DR by population subgroup. RESULTS The prevalence of DR was 48.4% in the population type 1 diabetes mellitus (T1DM) (14 846/30 657) and 28.3% (95 807/338 390) in the population with type 2 diabetes mellitus (T2DM). Prevalence of DR remained stable in people with T2DM and decreased in people with T1DM. Screening for DR increased over time for patients with T2DM and remained static for patients with T1DM Incidence of DR increased in parallel with the incidence of T2DM in both diabetic populations. Among patients with T2DM, relative risk of DR varied significantly by region, was increased for older age groups and in men compared with women, with risk of severe DR increased in South Asian groups and more deprived groups. Relative risk of DR for patients with T1DM varied by age and region, but not by gender, ethnic group or deprivation. CONCLUSIONS This is the largest study to date examining the burden of DR in the UK. Regional disparities in incidence may relate to differences in screening delivery and disease ascertainment. Evidence that deprivation and ethnicity are associated with a higher risk of severe DR highlights a significant potential health inequality. Findings from this study will have implications for professionals working in the diabetes and sight loss sectors, particularly to inform approaches for diagnosis of retinopathy and campaigning to better tackle the disease for at risk groups.
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Affiliation(s)
- Rohini Mathur
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Krishnan Bhaskaran
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma Edwards
- Royal National Institute of Blind People, London, UK
| | - Helen Lee
- Royal National Institute of Blind People, London, UK
| | | | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian Douglas
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Stegemann S. Towards better understanding of patient centric drug product development in an increasingly older patient population. Int J Pharm 2016; 512:334-342. [DOI: 10.1016/j.ijpharm.2016.01.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/19/2016] [Indexed: 01/08/2023]
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Tracey ML, McHugh SM, Fitzgerald AP, Buckley CM, Canavan RJ, Kearney PM. Risk Factors for Macro- and Microvascular Complications among Older Adults with Diagnosed Type 2 Diabetes: Findings from The Irish Longitudinal Study on Ageing. J Diabetes Res 2016; 2016:5975903. [PMID: 27294152 PMCID: PMC4884580 DOI: 10.1155/2016/5975903] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/26/2016] [Indexed: 12/17/2022] Open
Abstract
Objective. To explore risk factors for macro- and microvascular complications in a nationally representative sample of adults aged 50 years and over with type 2 diabetes in Ireland. Methods. Data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) (2009-2011) was used in cross-sectional analysis. The presence of doctor diagnosis of diabetes, risk factors, and macro- and microvascular complications were determined by self-report. Gender-specific differences in risk factor prevalence were assessed with the chi-squared test. Binomial regression analysis was conducted to explore independent associations between established risk factors and diabetes-related complications. Results. Among 8175 respondents, 655 were classified as having type 2 diabetes. Older age, being male, a history of smoking, a lower level of physical activity, and a diagnosis of high cholesterol were independent predictors of macrovascular complications. Diabetes diagnosis of 10 or more years, a history of smoking, and a diagnosis of hypertension were associated with an increased risk of microvascular complications. Older age, third-level education, and a high level of physical activity were protective factors (p < 0.05). Conclusions. Early intervention to target modifiable risk factors is urgently needed to reduce diabetes-related morbidity in the older population in Ireland.
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Affiliation(s)
- Marsha L. Tracey
- Department of Epidemiology and Public Health, University College Cork, Western Road, Western Gateway Building, Cork, Ireland
| | - Sheena M. McHugh
- Department of Epidemiology and Public Health, University College Cork, Western Road, Western Gateway Building, Cork, Ireland
| | - Anthony P. Fitzgerald
- Department of Epidemiology and Public Health, University College Cork, Western Road, Western Gateway Building, Cork, Ireland
- Department of Statistics, University College Cork, Western Road, Western Gateway Building, Cork, Ireland
| | - Claire M. Buckley
- Department of Epidemiology and Public Health, University College Cork, Western Road, Western Gateway Building, Cork, Ireland
- Department of Public Health, Health Service Executive (HSE) South, St. Finbarr's Hospital, Douglas Road, Cork, Ireland
| | - Ronan J. Canavan
- Department of Endocrinology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Patricia M. Kearney
- Department of Epidemiology and Public Health, University College Cork, Western Road, Western Gateway Building, Cork, Ireland
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