Diabetic retinopathy equity profile in a multi-ethnic, deprived population in Northern England

Abstract

Purpose Equity profiles are an established public health tool used to systematically identify and address inequity within health and health services. Our aim was to conduct an equity profile to identify inequity in eye health across Leeds and Bradford. This paper presents results of findings for diabetic retinopathy in Bradford and Airedale. Methods A variety of routine health data were included and sub-analysed by measures of equity, including age, sex, ethnicity, and deprivation to identify inequity in eye health and healthcare. The Spearman Rank Correlation Coefficient was used to determine the association between variables. Results The prevalence of diagnosed diabetes in Bradford and Airedale district is 6.6% compared to 4.3% in nearby Leeds and 5.1% nationally. The age-standardised prevalence of diagnosed diabetic retinopathy within Bradford and Airedale is 2.21% (95% CI 1.54-2.26%), with a disproportionately high prevalence of disease in the Pakistani population and the most deprived parts of the population. There was a poorer uptake of diabetic retinopathy screening in more deprived parts of the district and the proportions with a higher rate of referral to ophthalmology following the screening in Black and Minority Ethnic populations compared with the white population (13.2% vs 6.9%). Uptake of secondary care outpatient appointments is much lower in more deprived populations. Conclusion Inequalities are inherent in diabetic retinopathy prevalence, diagnosis, and treatment. The reasons for these inequities are multi-factorial and further investigation of reasons for poor uptake of services is required. Addressing the inequalities in eye health and healthcare requires cross-organisational collaboration.

Socioeconomic factors associated with visual impairment and ophthalmic care utilization in patients with type II diabetes

“…49 There is considerable evidence that SES may determine the risk for diabetic eye complications, such as retinopathy, that ultimately have an impact on quality of life. 14,20,29 Our findings support previous research that income is a predictor of visual impairment among patients with diabetes. 29 However, the causal link between income and eye complication is still unclear.…”

“…Similarly, under the universal health care system in the United Kingdom, the rate of DR screening was significantly lower in patients residing in deprived areas. 15,20,21 Because there is a strong socioeconomic health gradient, 22 and use of ophthalmic clinical care is less frequent in patients with lower SES, it would follow that lower SES is also a key predictor of increased rates of diabetic eye complications. 12,20,[23][24][25][26][27][28] Accordingly, Brown et al 29 found that lower SES, as measured by individual or household income, education, employment, occupation, or living in an underprivileged area, was associated with increased risk for microvascular disease, including diabetic eye complications.…”

Area deprivation, individual socioeconomic status and low vision in the EPIC-Norfolk Eye Study

“…Findings from a health equity audit from Leeds supported these results and also identified fewer optometry practices in areas of high deprivation 22. Similar disparities between health needs and health services were found for diabetic retinopathy 23. The Tudor Hart inverse care law states that availability of good medical care tends to vary inversely with the need of the population, particularly where medical care is exposed to market forces 32.…”

Influence of primary care practices on patients’ uptake of diabetic retinopathy screening: a qualitative case study

“…Patients’ lack of awareness, psychological factors (fear and guilt), or practical obstacles, such as obtaining time off work, were also important 9. Patients living in the most deprived areas were less likely to attend for screening while having worse retinopathy 10,11. Uptake rates in the same area can vary between practices from 55% to 95%; practices can have a higher, or lower, uptake rate than suggested by their patient population 12.…”