Author Block: Gareth D. Mercer, Baixiang Xiao, Han Lin Lee, Congyao Wang, Alastair Denniston, Cathy Egan, Nathan Congdon

Author Disclosure Block: G.D. Mercer: None. B. Xiao: None. H. Lee: None. C. Wang: None. A. Denniston: None. C. Egan: None. N. Congdon: Any direct financial payments including receipt of honoraria; ORBIS International (Director of Research).

Abstract Body:

Purpose: Social inequities in access to screening for Diabetic Retinopathy (DR) limit the effectiveness of this important public health intervention. We examined whether community-level outreach screening in China would improve equity in access.

Study Design: Comparison of three cross-sectional studies of diabetic adults aged ≥50 years from Guangdong province, China.

Methods: Using multinomial logistic regression we compared the distribution of indicators of socioeconomic disadvantage (female sex, older age, lower educational attainment) and sight-threating diabetic retinopathy (STDR, severe non-proliferative or proliferative retinopathy and/or macular edema) between the following three groups: people with diabetes presenting spontaneously for eye examinations at secondary-level hospitals (n=193); those screened through a primary-level DR outreach program (n=178); and individuals with newly- or previously-diagnosed diabetes examined as part of a population-based survey (n=579). The population-based cohort was used as the reference group, reflecting the “ideal” reach of a screening program. All studies received approval from the Ethics Committee of the Zhongshan Ophthalmic Center, Guangzhou, China.

Results: Routine eye care through secondary-level hospitals, as compared to population-based screening, appeared to be less likely to reach older adults (75 years and older vs. younger than 75, OR=0.30, 95% CI: 0.16-0.55) and those with lower educational attainment (primary school or lower vs. middle school or higher, OR=0.08, 95% CI: 0.05-0.12), but not less likely to reach women (OR=1.09, 95% CI: 0.74-1.61). Similar patterns were observed when comparing community-level outreach screening to population-based screening, however, this strategy appeared to improve access when compared to spontaneous hospital presentation for older adults (75 years and older vs. younger than 75, OR=0.55, 95% CI: 0.35-0.89) and those with lower educational attainment (primary school or lower vs. middle school or higher, OR=0.27, 95% CI: 0.18-0.42). Again, women were as likely to be reached by community-level screening as by population-based screening after accounting for age and educational attainment (OR=1.18, 95% CI: 0.82-1.62). Compared to the population-based screening sample, the risk of having STDR was higher in the primary-level hospital screening sample (OR=2.32, 95% CI: 1.13-4.75), and lower in the tertiary-level hospital sample (OR=0.23, 95% CI: 0.05-1.01).

Conclusions: Community-level outreach screening for DR may improve access for older adults and those with lower educational attainment. Such screening may also detect greater numbers of individuals with sight threatening retinopathy.