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Global issues
Prevalence and risk factors for diabetic retinopathy in China: a multi-hospital-based cross-sectional study
  1. Guihua Zhang,
  2. Haoyu Chen,
  3. Weiqi Chen,
  4. Mingzhi Zhang
  1. Department of Ophthalmology, The Joint Shantou International Eye Center (JSIEC) of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
  1. Correspondence to Dr Mingzhi Zhang, Department of Ophthalmology, The Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Dongxia Road, Jingping District, Shantou 515041, Guangdong, China; zmz{at}jsiec.org

Abstract

Purpose To determine the prevalence and risk factors for diabetic retinopathy (DR) and sight-threatening diabetic retinopathy (STDR) in a multi-hospital-based DR screening programme among patients with diabetes in China, the Lifeline Express Diabetic Retinopathy Screening Program.

Methods Patients with diabetes in eight hospitals across mainland China (both southern and northern) from January 2014 to July 2016 were recruited in this programme. All participants underwent a standardised interview and examinations and received digital fundus photography. DR severity was graded from retinal fundus photographs by retina specialists in the reading centre of Joint Shantou International Eye Center, according to the grading standards of the English National Screening Programme. STDR was defined as the presence of preproliferative DR (R2), proliferative DR (R3) and/or maculopathy (M1).

Results 16 305 patients with diabetes were screened for DR in total. Fundus photographs were gradable for 15 078 patients (92.5%). The age–gender-standardised prevalence of any DR and STDR was 27.9% (95% CI, 27.2% to 28.6%) and 12.6% (95% CI, 12.1% to 13.1%), respectively. In the multiple logistic regression analysis, younger age (OR, 0.967), longer duration of diabetes (OR, 1.093), higher haemoglobin A1c (OR, 1.115), higher fasting plasma glucose (OR, 1.074), higher systolic blood pressure (OR, 1.014), faster heart rate (OR, 1.010), higher low-density lipoprotein (OR, 1.149), lower triglycerides (OR, 0.975), higher blood urea nitrogen (BUN) (OR, 1.012) and elevated serum creatinine level (OR, 1.003) were associated with the presence of DR. Similar risk factors, except for BUN and triglycerides, were found for STDR.

Conclusions The prevalence of DR and STDR in diabetes was 27.9% and 12.6%, respectively in this multi-hospital-based population across China. Compared with Western population with diabetes, similar risk factors for DR and STDR were found in Chinese patients with diabetes.

  • Retina
  • Epidemiology
  • Public Health

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bjophthalmol-2017-310316

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    Footnotes

    • Contributors GZ contributed to the design of the work, acquisition of data and analysis and interpretation of data; drafting the work and revising it critically for important intellectual content. HC contributed to the analysis and interpretation of data. WC critically revised the manuscript for important intellectual content. MZ made substantial contribution to the conception and design of the work; analysis and interpretation of data; drafting the work and revising it critically for important intellectual content.

    • Funding The programme was supported by Chinese Foundation for Lifeline Express and Lifeline Express Hong Kong Foundation.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Hospital ethics committees.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The unpublished data are still being acquired for continuous screening programme. The data ownership belongs to the Chinese Foundation for Lifeline Express and Lifeline Express Hong Kong Foundation. The authors are authorised to use the data from the programme.