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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

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
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

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.

diabetes, electronic medical record
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Denniston, Alastair K.
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Lee, Aaron Y.
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Lee, Cecilia S.
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Lip, Peck Lin
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Taylor, Paul
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Pikoula, Maria
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Cook, Esther
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Akerele, Toks
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Brand, Christopher
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Patra, Sudeshna
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Paul, Bobby
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Sim, Dawn A.
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Talks, James Stephen
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Wilkinson, Elizabeth
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Tufail, Adnan
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Antcliff, Richard
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Kumar, Vineeth
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Lobo, Aires
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Lotery, Andrew
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Patra, Sudeshna
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Paul, Bobby
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Sim, Dawn A.
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Talks, James Stephen
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Wilkinson, Elizabeth
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Tufail, Adnan
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Denniston, Alastair K., Lee, Aaron Y., Lee, Cecilia S., Crabb, David P., Bailey, Clare, Lip, Peck Lin, Taylor, Paul, Pikoula, Maria, Cook, Esther, Akerele, Toks, Antcliff, Richard, Brand, Christopher, Chakravarthy, Usha, Chavan, Randhir, Dhingra, Narendra, Downey, Louise, Eleftheriadis, Haralabos, Ghanchi, Faruque, Khan, Rehna, Kumar, Vineeth, Lobo, Aires, Lotery, Andrew, Menon, Geeta, Mukherjee, Rajarshi, Palmer, Helen, Patra, Sudeshna, Paul, Bobby, Sim, Dawn A., Talks, James Stephen, Wilkinson, Elizabeth, Tufail, Adnan and Egan, Catherine A. (2018) 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. British Journal of Ophthalmology. (doi:10.1136/bjophthalmol-2018-312568).

Record type: Article

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.

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bjophthalmol-2018-312568.full - Version of Record
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More information

Accepted/In Press date: 7 July 2018
e-pub ahead of print date: 29 September 2018
Keywords: diabetes, electronic medical record

Identifiers

Local EPrints ID: 425361
URI: http://eprints.soton.ac.uk/id/eprint/425361
ISSN: 0007-1161
PURE UUID: a31b62c2-cc76-4f78-9a58-8339921bad10
ORCID for Andrew Lotery: ORCID iD orcid.org/0000-0001-5541-4305

Catalogue record

Date deposited: 16 Oct 2018 16:30
Last modified: 26 Nov 2021 02:46

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Contributors

Author: Alastair K. Denniston
Author: Aaron Y. Lee
Author: Cecilia S. Lee
Author: David P. Crabb
Author: Clare Bailey
Author: Peck Lin Lip
Author: Paul Taylor
Author: Maria Pikoula
Author: Esther Cook
Author: Toks Akerele
Author: Richard Antcliff
Author: Christopher Brand
Author: Usha Chakravarthy
Author: Randhir Chavan
Author: Narendra Dhingra
Author: Louise Downey
Author: Haralabos Eleftheriadis
Author: Faruque Ghanchi
Author: Rehna Khan
Author: Vineeth Kumar
Author: Aires Lobo
Author: Andrew Lotery ORCID iD
Author: Geeta Menon
Author: Rajarshi Mukherjee
Author: Helen Palmer
Author: Sudeshna Patra
Author: Bobby Paul
Author: Dawn A. Sim
Author: James Stephen Talks
Author: Elizabeth Wilkinson
Author: Adnan Tufail
Author: Catherine A. Egan

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