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Abstract
Purpose To determine associations between deprivation using the Index of Multiple Deprivation (IMD and individual IMD subdomains) with incident referable diabetic retinopathy/maculopathy (termed rDR).
Methods Anonymised demographic and screening data collected by the South-East London Diabetic Eye Screening Programme were extracted from September 2013 to December 2019. Multivariable Cox proportional models were used to explore the association between the IMD, IMD subdomains and rDR.
Results From 118 508 people with diabetes who attended during the study period, 88 910 (75%) were eligible. The mean (± SD) age was 59.6 (±14.7) years; 53.94% were male, 52.58% identified as white, 94.28% had type 2 diabetes and the average duration of diabetes was 5.81 (±6.9) years; rDR occurred in 7113 patients (8.00%). Known risk factors of younger age, Black ethnicity, type 2 diabetes, more severe baseline DR and diabetes duration conferred a higher risk of incident rDR. After adjusting for these known risk factors, the multivariable analysis did not show a significant association between IMD (decile 1 vs decile 10) and rDR (HR: 1.08, 95% CI: 0.87 to 1.34, p=0.511). However, high deprivation (decile 1) in three IMD subdomains was associated with rDR, namely living environment (HR: 1.64, 95% CI: 1.12 to 2.41, p=0.011), education skills (HR: 1.64, 95% CI: 1.12 to 2.41, p=0.011) and income (HR: 1.19, 95% CI: 1.02 to 1.38, p=0.024).
Conclusion IMD subdomains allow for the detection of associations between aspects of deprivation and rDR, which may be missed when using the aggregate IMD. The generalisation of these findings outside the UK population requires corroboration internationally.
- Retina, Diabetes,
Data availability statement
No data are available. The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned (and, if relevant, registered) have been explained. No additional data are available.
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Data availability statement
No data are available. The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned (and, if relevant, registered) have been explained. No additional data are available.
Footnotes
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Contributors Conceptualisation: PN, JMNdR, LW, SM, DH, MJC, MM, CB and TLJ. Design: PN and TLJ. Methods: PN and TLJ. Data extraction: PN and LW. Data analysis: PG and PN. Supervision: PN, JMNdR, CB and TLJ. Manuscript drafting: PG and PN. Manuscript review, revision and final approval: PG, PN, JMNdR, LW, SM, DH, MJC, MM, CB and TLJ. PG and PN had access to, analysed and attest to the integrity and completeness of the study data. PG is the guarantor.
Funding This study is funded by Diabetes UK via the Sir George Alberti research training fellowship grant to PN, supervised by TLJ (grant number: 20/0006144). The funder (Diabetes UK) did not have access to any of the study data, nor did they influence the conduct of this study, including the study design, data extraction, model development, data analysis or draft manuscript. The funder also did not influence submitting the article for publication. We operated completely independent from the funders.
Competing interests PG, PN, JMNdR, LW, SM, DH, MJC, MM and CB has no conflicts of interest to declare. TLJ’ employer (King’s College Hospital) receives funding for participants enrolled on commercial clinical trials of diabetic retinopathy including THR149-002 (sponsor: OXURION), NEON NPDR (sponsor: BAYER), RHONE-X (sponsor: ROCHE) and ALTIMETER (sponsor: ROCHE). He is a paid advisor to solicitors acting for REGENERON and has received conference support from ROCHE.
Provenance and peer review Not commissioned; externally peer reviewed.
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