Outreach Screening to Address Demographic and Economic Barriers to Diabetic Retinopathy Care in Rural China

Abstract

Background: Poor access to existing care for diabetic retinopathy (DR) limits effectiveness of proven treatments. We examined whether outreach screening in rural China improves equity of access. Methods: We compared prevalence of female sex, age >=65 years, primary education or below, and requiring referral care for DR between three cohorts with diabetes examined for DR in neighboring areas of Guangdong, China: passive case detection at secondary-level hospitals (n=193); persons screened during primary-level DR outreach (n=185); and individuals with newly- or previously-diagnosed diabetes in a population survey (n=579). The latter reflected the “ideal” reach of a screening program. Findings: Compared to the population cohort, passive case detection reached fewer women (50·8% vs. 62·3%, p = 0·006), older adults (37·8% vs. 51·3%, p 0.300) and persons aged >= 65 years (49.5% vs 51.3%, p=0.723) in the outreach screening and population cohorts did not differ significantly. Prevalence of requiring referral care for DR was significantly higher in the outreach screening cohort (28·0%) than the population (14·0%) and passive case detection cohorts (7·3%, p<0·001 for both). Interpretation: Primary-level outreach screening improves access for the poorly-educated and elderly, and removes gender inequity in access to DR care in this setting, while also identifying more severely-affected patients than case finding in hospital. Funding Statement: Orbis International, Zhongshan Ophthalmic Center, Sun Yat-sen University, Bayer, Ulverscroft Foundation (UK). Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: Approval for the parent studies from which the secondarylevel and population cohorts were drawn, and for enrolment of new patients from the township clinics, were all provided by the Ethics Committee at the Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China, written informed consent was obtained from all participants, and the tenets of the Declaration of Helsinki were followed throughout.