J Korean Ophthalmol Soc.  2012 Apr;53(4):516-521.

Factors Associated with Screening for Diabetic Retinopathy in Diabetic Patients Aged > or = 40 Years Using the KNHANES IV

• Lim HT
• Choi KS

Abstract

PURPOSE
To identify factors associated with care of diabetic retinopathy.
METHODS
The fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) is a nationwide survey. This survey included 1, 257 people aged 40 years and older with a history of diabetic mellitus who answered questions, "Within one year, have you ever received eye examination (fundus photography) for screening diabetic retinopathy?" Factors that affect care of diabetic retinopathy were identified using multiple logistic regression analysis.
RESULTS
Among the 1,257 people aged 40 years and older, 464 (36.9%) received screening for diabetic retinopathy. People aged 65 years and older (aOR = 0.7, 95% CI: 0.51-0.85) with university education (aOR = 0.5, 95% CI: 0.32-0.74) were more likely to undergo screening for diabetic retinopathy compared to those in the reference category (40-64 years old and those who had elementary school or lower education). People living in rural areas were less likely to undergo screening for diabetic retinopathy compared to those living in urban areas (aOR = 1.7, 95% CI: 1.32-2.24). Diabetic retinopathy screening was also associated with self-reported health status (ref: unhealthy [aOR = 1], fair [aOR = 1.7, 95% CI: 1.25-2.23], and healthy [aOR = 1.8, 95% CI: 1.30-2.44]).
CONCLUSIONS
To increase nationwide screening rates for diabetic retinopathy, more attention should be given to underserved groups, particularly people aged between 40 and 64 years, those with a low education level, those living in rural areas, and those with a positive attitude toward self-reported health status. These issues highlight the need for a new emphasis in health education and public health policies aimed towards these underserved groups.

Keyword

Diabetes care; Diabetic retinopathy screening; KNHANES; Socio-demographic factors

MeSH Terms

Aged
Diabetic Retinopathy
Eye
Health Education
Humans
Korea
Logistic Models
Mass Screening
Nutrition Surveys
Public Health

Reference

1. Congdon NG, Friedman DS, Lietman T. Important causes of visual impairment in the world today. JAMA. 2003. 290:2057–2060.

2. Varma R. From a population to patients: the Wisconsin epidemiologic study of diabetic retinopathy. Ophthalmology. 2008. 115:1857–1858.

3. Braveman P. Health disparities and health equity: concepts and measurement. Annu Rev Public Health. 2006. 27:167–194.

4. Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Trends in the quality of care and racial disparities in Medicare managed care. N Engl J Med. 2005. 353:692–700.

5. Hale NL, Bennett KJ, Probst JC. Diabetes care and outcomes: disparities across rural America. J Community Health. 2010. 35:365–374.

6. Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults--United States, 1992, and changes in the definition of current cigarette smoking. MMWR Morb Mortal Wkly Rep. 1994. 43:342–346.

7. Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000. 32:9 Suppl. S498–S504.

8. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000. 894:i–xii. 1–253.

9. Deaton A, Lubotsky D. Mortality, inequality and race in American cities and states. Soc Sci Med. 2003. 56:1139–1153.

10. Fung MM, Yap MK, Cheng KK. Community-based diabetic retinopathy screening in Hong Kong: ocular findings. Clin Exp Optom. 2011. 94:63–66.

11. Sequist TD, Cullen T, Bernard K, et al. Trends in quality of care and barriers to improvement in the Indian Health Service. J Gen Intern Med. 2011. 26:480–486.

12. Yudkin JS, Boucher BJ, Schopflin KE, et al. The quality of diabetic care in a London health district. J Epidemiol Community Health. 1980. 34:277–280.

13. Beckles GL, Zhu J, Moonesinghe R. Centers for Disease Control and Prevention (CDC). Diabetes - United States, 2004 and 2008. MMWR Surveill Summ. 2011. 60:Suppl. 90–93.

14. Nelson DE, Bland S, Powell-Griner E, et al. State trends in health risk factors and receipt of clinical preventive services among US adults during the 1990s. JAMA. 2002. 287:2659–2667.

15. Ebrahim SH, Floyd RL, Merritt RK 2nd, et al. Trends in pregnancy-related smoking rates in the United States, 1987-1996. JAMA. 2000. 283:361–366.

16. Zhang Q, Wang Y. Trends in the association between obesity and socioeconomic status in US adults: 1971 to 2000. Obes Res. 2004. 12:1622–1632.

17. Hardman K, Hunt KJ, Carter RE, et al. Diabetes management and vaccination rates in the Southeast United States, 2000 through 2007. Ethn Dis. 2011. 21:13–19.

18. Ford ES, Li C, Zhao G, et al. Trends in low-risk lifestyle factors among adults in the United States: findings from the Behavioral Risk Factor Surveillance System 1996-2007. Prev Med. 2010. 51:403–407.

19. Lee K, Lim HT, Hwang SS, et al. Socio-economic disparities in behavioural risk factors for cancer and use of cancer screening services in Korean adults aged 30 years and older: the Third Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III). Public Health. 2010. 124:698–704.

20. Lee K, Lim HT, Park SM. Factors associated with use of breast cancer screening services by women aged>or= 40 years in Korea: the third Korea National Health and Nutrition Examination Survey 2005 (KNHANES III). BMC Cancer. 2010. 10:144.

21. Kwon YM, Lim HT, Lee K, et al. Factors associated with use of gastric cancer screening services in Korea. World J Gastroenterol. 2009. 15:3653–3659.