Personalized risk-based screening for diabetic retinopathy: a multivariate approach versus the use of stratification rules
Personalized risk-based screening for diabetic retinopathy: a multivariate approach versus the use of stratification rules
Aims: to evaluate our proposed multivariate approach to identify patients who will develop sight-threatening diabetic retinopathy (STDR) within a 1-year screen interval, and explore the impact of simple stratification rules on prediction.
Materials and methods: a 7-year dataset (2009-2016) from people with diabetes (PWD) was analysed using a novel multivariate longitudinal discriminant approach. Level of diabetic retinopathy, assessed from routine digital screening photographs of both eyes, was jointly modelled using clinical data collected over time. Simple stratification rules based on retinopathy level were also applied and compared with the multivariate discriminant approach.
Results: data from 13 103 PWD (49 520 screening episodes) were analysed. The multivariate approach accurately predicted whether patients developed STDR or not within 1 year from the time of prediction in 84.0% of patients (95% confidence interval [CI] 80.4-89.7), compared with 56.7% (95% CI 55.5-58.0) and 79.7% (95% CI 78.8-80.6) achieved by the two stratification rules. While the stratification rules detected up to 95.2% (95% CI 92.2-97.6) of the STDR cases (sensitivity) only 55.6% (95% CI 54.5-56.7) of patients who did not develop STDR were correctly identified (specificity), compared with 85.4% (95% CI 80.4-89.7%) and 84.0% (95% CI 80.7-87.6%), respectively, achieved by the multivariate risk model.
Conclusions: accurate prediction of progression to STDR in PWD can be achieved using a multivariate risk model whilst also maintaining desirable specificity. While simple stratification rules can achieve good levels of sensitivity, the present study indicates that their lower specificity (high false-positive rate) would therefore necessitate a greater frequency of eye examinations.
cohort study, diabetic retinopathy, observational study, primary care
560-568
García-Fiñana, Marta
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Hughes, David M.
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Cheyne, Christopher P.
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Broadbent, Deborah M.
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Wang, Amu
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Komárek, Arnošt
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Stratton, Irene M.
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Mobayen-Rahni, Mehrdad
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Alshukri, Ayesh
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Vora, Jiten P.
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Harding, Simon P.
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30 October 2018
García-Fiñana, Marta
3ed2efab-455f-42bf-ae3e-4171a6af98ed
Hughes, David M.
0113dc91-f7f0-4a69-8c06-19b17ca90a6b
Cheyne, Christopher P.
ec078d25-27f4-4e9f-a8ed-0066d33a492c
Broadbent, Deborah M.
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Wang, Amu
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Komárek, Arnošt
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Stratton, Irene M.
772f25b9-23c0-4240-a3f6-1e76b03b172f
Mobayen-Rahni, Mehrdad
7c070398-c9b9-4cc7-b7a8-c95b1ce70a09
Alshukri, Ayesh
882eff3f-3f75-4c29-8d9e-354984a6486a
Vora, Jiten P.
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Harding, Simon P.
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García-Fiñana, Marta, Hughes, David M., Cheyne, Christopher P., Broadbent, Deborah M., Wang, Amu, Komárek, Arnošt, Stratton, Irene M., Mobayen-Rahni, Mehrdad, Alshukri, Ayesh, Vora, Jiten P. and Harding, Simon P.
(2018)
Personalized risk-based screening for diabetic retinopathy: a multivariate approach versus the use of stratification rules.
Diabetes, Obesity and Metabolism, 21 (3), .
(doi:10.1111/dom.13552).
Abstract
Aims: to evaluate our proposed multivariate approach to identify patients who will develop sight-threatening diabetic retinopathy (STDR) within a 1-year screen interval, and explore the impact of simple stratification rules on prediction.
Materials and methods: a 7-year dataset (2009-2016) from people with diabetes (PWD) was analysed using a novel multivariate longitudinal discriminant approach. Level of diabetic retinopathy, assessed from routine digital screening photographs of both eyes, was jointly modelled using clinical data collected over time. Simple stratification rules based on retinopathy level were also applied and compared with the multivariate discriminant approach.
Results: data from 13 103 PWD (49 520 screening episodes) were analysed. The multivariate approach accurately predicted whether patients developed STDR or not within 1 year from the time of prediction in 84.0% of patients (95% confidence interval [CI] 80.4-89.7), compared with 56.7% (95% CI 55.5-58.0) and 79.7% (95% CI 78.8-80.6) achieved by the two stratification rules. While the stratification rules detected up to 95.2% (95% CI 92.2-97.6) of the STDR cases (sensitivity) only 55.6% (95% CI 54.5-56.7) of patients who did not develop STDR were correctly identified (specificity), compared with 85.4% (95% CI 80.4-89.7%) and 84.0% (95% CI 80.7-87.6%), respectively, achieved by the multivariate risk model.
Conclusions: accurate prediction of progression to STDR in PWD can be achieved using a multivariate risk model whilst also maintaining desirable specificity. While simple stratification rules can achieve good levels of sensitivity, the present study indicates that their lower specificity (high false-positive rate) would therefore necessitate a greater frequency of eye examinations.
Text
Diabetes Obesity Metabolism - 2018 - García‐Fiñana - Personalized risk‐based screening for diabetic retinopathy A
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Accepted/In Press date: 30 September 2018
e-pub ahead of print date: 3 October 2018
Published date: 30 October 2018
Additional Information:
Funding Information: EPSRC, Grant/Award Number: EP/N014499/1; National Institute for Health Research, Grant/Award Number: RP-PG-1210-12016; Medical Research Council, MRC, Grant/Award Number: DiALog MR/L010909/1M.G.F, D.M.H and S.P.H acknowledge support from the UK Medical Research Council (Research project MR/L010909/1). M.G.F. also acknowledges support of the UK The Engineering and Physical Sciences Research Council (EPSRC) grant EP/N014499/1. This manuscript presents independent research funded by the National Institute for Health Research (NIHR; RP-PG-1210-12016). The views expressed are those of the authors, not those of the UK National Health Service, NIHR or Department of Health. The authors are grateful to the Liverpool ISDR Study Group.
Funding Information: M.G.F, D.M.H and S.P.H acknowledge support from the UK Medical Research Council (Research project MR/L010909/1). M.G.F. also acknowledges support of the UK The Engineering and Physical Sciences Research Council (EPSRC) grant EP/N014499/1. This manuscript presents independent research funded by the National Institute for Health Research (NIHR; RP-PG-1210-12016). The views expressed are those of the authors, not those of the UK National Health Service, NIHR or Department of Health. The authors are grateful to the Liverpool ISDR Study Group.
Keywords:
cohort study, diabetic retinopathy, observational study, primary care
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Local EPrints ID: 487098
URI: http://eprints.soton.ac.uk/id/eprint/487098
ISSN: 1462-8902
PURE UUID: 51a2e329-c296-4ec9-90c6-55d20f85ff28
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Date deposited: 13 Feb 2024 17:32
Last modified: 18 Mar 2024 04:01
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Contributors
Author:
Marta García-Fiñana
Author:
David M. Hughes
Author:
Christopher P. Cheyne
Author:
Deborah M. Broadbent
Author:
Amu Wang
Author:
Arnošt Komárek
Author:
Irene M. Stratton
Author:
Mehrdad Mobayen-Rahni
Author:
Ayesh Alshukri
Author:
Jiten P. Vora
Author:
Simon P. Harding
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