Sadat Mahmoudi Nezhad Golnoush, Razeghinejad Reza, Janghorbani Mohsen, Mohamadian Alireza, Hassan Jalalpour Mohammad, Bazdar Somaye, Salehi Alireza, Molavi Vardanjani Hossein
MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran.
Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran.
J Ophthalmic Vis Res. 2019 Jul 18;14(3):321-335. doi: 10.18502/jovr.v14i3.4790. eCollection 2019 Jul-Sep.
To estimate the pooled prevalence and incidence of diabetic retinopathy (DR) in Iran and to investigate their correlations with the Human Development Index (HDI), healthcare access (i.e., density of specialists and sub-specialists), and methodological issues.
Electronic databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and local databases were searched for cohort and cross-sectional studies published prior to January 2018. Prevalence and incidence rates of DR were extracted from January 2000 to December 2017 and random effects models were used to estimate pooled effect sizes. The Joanna Briggs Institute critical appraisal tool was applied for quality assessment of eligible studies.
A total of 55,445 participants across 33 studies were included. The pooled prevalence (95% CI) of DR in diabetic clinics (22 studies), eye clinics (4 studies), and general population (7 studies) was 31.8% (24.5 to 39.2), 57.8% (50.2 to 65.3), and 29.6% (22.6 to 36.5), respectively. It was 7.4% (3.9 to 10.8) for proliferative DR and 7.1% (4.9 to 9.4) for clinically significant macular edema. The heterogeneity of individual estimates of prevalence was highly significant. HDI ( < 0.001), density of specialists ( = 0.004), subspecialists ( < 0.001), and sampling site ( = 0.041) were associated with heterogeneity after the adjustment for type of DR, duration of diabetes, study year, and proportion of diabetics with controlled HbA1C.
Human development and healthcare access were correlated with the prevalence of DR. Data were scarce on the prevalence of DR in less developed provinces. Participant recruitment in eye clinics might overestimate the prevalence of DR.
评估伊朗糖尿病视网膜病变（DR）的合并患病率和发病率，并研究其与人类发展指数（HDI）、医疗保健可及性（即专科医生和亚专科医生的密度）以及方法学问题之间的相关性。
检索电子数据库，如PubMed、Embase、Scopus、科学网、谷歌学术以及本地数据库，查找2018年1月之前发表的队列研究和横断面研究。提取2000年1月至2017年12月期间DR的患病率和发病率，并使用随机效应模型估计合并效应量。采用乔安娜·布里格斯研究所的批判性评价工具对符合条件的研究进行质量评估。
共纳入33项研究中的55445名参与者。糖尿病诊所（22项研究）、眼科诊所（4项研究）和普通人群（7项研究）中DR的合并患病率（95%CI）分别为31.8%（24.5至39.2）、57.8%（50.2至65.3）和29.6%（22.6至36.5）。增殖性DR为7.4%（3.9至10.8），临床显著性黄斑水肿为7.1%（4.9至9.4）。个体患病率估计值的异质性非常显著。在对DR类型、糖尿病病程、研究年份以及糖化血红蛋白A1C控制良好的糖尿病患者比例进行调整后，HDI（<0.001）、专科医生密度（=0.004）、亚专科医生密度（<0.001）和抽样地点（=0.041）与异质性相关。
人类发展和医疗保健可及性与DR的患病率相关。欠发达省份DR患病率的数据较少。在眼科诊所招募参与者可能会高估DR的患病率。
