Equity of uptake of a diabetic retinopathy screening programme in a geographically and socio-economically diverse population

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Orton, Elizabeth ; Forbes-Haley, A. ; Tunbridge, L. ; Cohenc, S. (2013)
  • Publisher: WB Saunders
  • Journal: Public Health, volume 127, issue 9, pages 814-821 (issn: 0033-3506)
  • Related identifiers: doi: 10.1016/j.puhe.2013.04.015
  • Subject: Public Health, Environmental and Occupational Health

Objectives\ud At the time of undertaking the audit, the uptake of diabetic retinopathy screening in Derbyshire was 73%, below the national standard of 80%. To assess equity of access to diabetic retinopathy screening in a geographically and ethnically diverse population and determine predictors for poor uptake that will inform service improvements.\ud \ud Study design\ud Mixed methods health equity audit.\ud \ud Methods\ud Postal questionnaires were issued to 1000 people invited for diabetic retinopathy screening in May 2010 and telephone interviews were conducted with subsample of 32 people who had not made a screening appointment. Routine data from the screening programme was used to identify characteristics of people who did not respond to screening invitation. The adjusted odds ratios (OR) and 95% confidence intervals (95% CI) using multivariate methods were calculated in this study.\ud \ud Results\ud The response rate to the postal questionnaire was 43%. Of these, 28% of respondents did not recall discussing the importance of diabetic retinopathy screening with their primary care team and 11% of people did not understand the term ‘diabetic retinopathy’. Non-uptake of screening was associated with deprivation (OR 1.19, 95% CI 1.10–1.29 for those living in the most deprived areas compared to the least deprived) and young people were over three times more likely not to participate than older people (OR 3.13, 95% CI 2.70–3.64 for men under 40 compared to men over 80 and OR 3.03, 95% CI 1.54–5.98 for people with type 1 diabetes under 40 compared to those over 80).\ud \ud Conclusions\ud Ensuring that primary care and other health care and third sector organisations convey the importance of diabetic retinopathy screening with patients and improving patients' understanding of the screening programme may improve uptake. Interventions to increase uptake should be targeted to younger people, especially those with type 1 diabetes and people living in more deprived areas.
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