United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services.

Denniston, Alastair K and Lee, Aaron Y and Lee, Cecilia S and Crabb, David P and Bailey, Clare and Lip, Peck-Lin and Taylor, Paul and Pikoula, Maria and Cook, Esther and Akerele, Toks and Antcliff, Richard and Brand, Christopher and Chakravarthy, Usha and Chavan, Randhir and Dhingra, Narendra and Downey, Louise and Eleftheriadis, Haralabos and Ghanchi, Faruque and Khan, Rehna and Kumar, Vineeth and Lobo, Aires and Lotery, Andrew and Menon, Geeta and Mukherjee, Rajarshi and Palmer, Helen and Patra, Sudeshna and Paul, Bobby and Sim, Dawn A and Talks, James Stephen and Wilkinson, Elizabeth and Tufail, Adnan and Egan, Catherine A (2019) United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services. The British journal of ophthalmology, 103 (6). pp. 837-843. ISSN 1468-2079. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: https://bjo.bmj.com/content/103/6/837

Abstract

AIM

To assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service.

METHODS

This is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main  outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment.

RESULTS

79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58).

CONCLUSIONS

This large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WW Eyes. Ophthalmology
Related URLs:
Depositing User: Jennifer Manders
Date Deposited: 02 Jan 2020 14:25
Last Modified: 02 Jan 2020 14:25
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2731

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