安大略省第一民族人群中的糖尿病致眼病：一项纵向、基于人群的队列研究。

Diabetes-induced eye disease among First Nations people in Ontario: a longitudinal, population-based cohort study.

机构信息

Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.

出版信息

CMAJ Open. 2020 Apr 17;8(2):E282-E288. doi: 10.9778/cmajo.20200005. Print 2020 Apr-Jun.

DOI:10.9778/cmajo.20200005

PMID:32303520

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7207040/

Abstract

BACKGROUND

In Canada, First Nations populations experience a higher incidence of diabetes and diabetes-related complications than other people. Given the paucity of information on use of preventive eye examinations and the need for interventional care for severe retinopathy among First Nations people, we carried out a population-based study to compare rates of eye examinations and interventional therapies to treat vision-threatening stages of diabetic retinopathy among First Nations people and other people with diabetes in Ontario.

METHODS

In collaboration with the Chiefs of Ontario, we carried out a population-based study to identify cohorts of First Nations people and other people with diabetes in Ontario from 1995/96 to 2014/15. We used linked health administrative databases to evaluate rates of eye examination (2005/06-2014/15) and severe diabetic retinopathy treatment and compared them between the 2 populations, and between First Nations people living in and outside of First Nations communities.

RESULTS

We identified 23 013 First Nations people and 1 364 222 other people diagnosed with diabetes from 1995/96 to 2014/15, of whom 49.8% (95% confidence interval [CI] 48.9%-50.7%) and 53.8% (95% CI 53.7%-54.0%), respectively, received an eye examination in 2014/15. Eye examination rates were similar for First Nations people regardless of whether they lived in or outside a First Nations community. First Nations people developed severe diabetic retinopathy at a faster rate than other people (hazard ratio 1.19, 95% CI 1.02-1.38). The gap between First Nations people and other people in the proportion requiring therapy for severe diabetic retinopathy was especially prominent among younger people. There were no significant differences in rates of diabetic retinopathy treatment in First Nations people stratified by place of residence.

INTERPRETATION

Eye examination rates remain suboptimal among people with diabetes in Ontario and were lower among First Nations people. This is particularly concerning in light of our other findings showing an increased risk of requiring treatment for advanced diabetic retinopathy and the accelerated rate of diabetic retinopathy progression among First Nations people with diabetes.

摘要

背景

在加拿大，第一民族人群的糖尿病发病率和糖尿病相关并发症发生率高于其他人群。鉴于第一民族人群在接受预防性眼科检查以及需要对严重视网膜病变进行干预性治疗方面的信息匮乏，我们开展了一项基于人群的研究，以比较安大略省第一民族人群和其他糖尿病患者的眼科检查率和治疗严重糖尿病性视网膜病变的干预性疗法，从而评估有威胁视力的糖尿病性视网膜病变各期的治疗率。

方法

我们与安大略省酋长合作，开展了一项基于人群的研究，以确定从 1995/96 年至 2014/15 年期间安大略省的第一民族人群和其他糖尿病患者队列。我们使用了关联的健康管理数据库来评估 2005/06 年至 2014/15 年期间的眼科检查率，并对这两个人群以及居住在和未居住在第一民族社区内的第一民族人群之间的治疗率进行了比较。

结果

我们从 1995/96 年至 2014/15 年期间确定了 23013 名第一民族人群和 1364222 名其他糖尿病患者，其中分别有 49.8%（95%置信区间[CI]：48.9%-50.7%）和 53.8%（95% CI：53.7%-54.0%）在 2014/15 年接受了眼科检查。无论是否居住在第一民族社区内，第一民族人群的眼科检查率都相似。与其他人群相比，第一民族人群发生严重糖尿病性视网膜病变的速度更快（风险比 1.19，95%CI：1.02-1.38）。在年轻人群中，第一民族人群和其他人群在需要治疗严重糖尿病性视网膜病变的比例方面的差距尤为明显。按居住地分层的第一民族人群的糖尿病性视网膜病变治疗率没有显著差异。