Abstract
We investigated the association between socioeconomic status (SES) and screening for diabetic retinopathy (DR) and diabetic nephropathy (DN) in community-dwelling diabetics. We analyzed data from 22,134 people with diabetes aged ≥19 years at the time of the nationwide 2015 Korean Community Health Survey. Multiple logistic regression analysis was used to explore the relationship between SES and screening for DR and DN both before and after adjustment for health behaviors, comorbidities, and educational level. Of all diabetic subjects, 33.9% and 38.1% underwent DR and DN screening, respectively. In the fully adjusted model, the extent of the DR and DN screening trended significantly lower as the educational level fell. Monthly household income was positively associated with DR screening, but a lower odds ratio (OR) for DN screening was evident only when the lowest and highest income groups were compared. Compared with managers/professionals, agricultural/forestry/fishery workers (OR 0.81, 95% confidence interval [CI] 0.69–0.96) and mechanical/manual laborers (OR 0.83, 95% CI 0.71–0.97) had lower ORs for DN screening. Residents in rural (compared with urban) areas and widows/widowers (compared with members of couples) were significantly less likely to undergo screening for DR and DN. Similar findings were obtained when the analysis was limited to those who had been educated about diabetes. In conclusion, socioeconomic inequalities were evident in terms of screening for DR and DN in community-dwelling Korean diabetics, regardless of whether they had reported receiving diabetes education. Tailored public health policies (and societal attention) are required to aid the socioeconomically disadvantaged.
Highlights
IntroductionOne of the leading causes of death worldwide, is rapidly increasing in prevalence
Diabetes mellitus, one of the leading causes of death worldwide, is rapidly increasing in prevalence
We explored whether socioeconomic inequalities in terms of diabetic retinopathy (DR) and diabetic nephropathy (DN) screening were still evident among subjects who had been educated on management of diabetic complications
Summary
One of the leading causes of death worldwide, is rapidly increasing in prevalence. Diabetic retinopathy (DR), a principal complication of diabetes, is a leading cause of preventable blindness and visual impairment [4]. As early detection and appropriate treatment of diabetic complications, including DR and DN, can improve the prognosis of diabetic patients [7,8], it is very important to manage diabetic complications in a timely manner; to this end, regular routine screening is essential. National Health Insurance data reveal that only 30% of diabetic patients underwent regular annual screening for DR (dilated fundus examination); the prevalence of DR in Korea has increased steadily [13]. Previous studies explored factors that reduced DR and DN screening [11,12], but few studies on large populations have comprehensively examined whether socioeconomic inequalities are in play in Korea. We explored whether socioeconomic inequalities in terms of DR and DN screening were still evident among subjects who had been educated on management of diabetic complications
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