Eye Clinic of National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, Accra, Ghana.
Department of Community Health, College of Health Sciences, University of Ghana Medical School, University of Ghana, Accra, Ghana.
BMC Health Serv Res. 2021 Jun 19;21(1):590. doi: 10.1186/s12913-021-06594-y.
There have been a major advance made in screening, early diagnosis, and prompt treatment of Diabetic Retinopathy among Person living with diabetes (PLWD). However, screening services remain a challenge in Low-Middle-Income-Countries where access to eye care professionals is inadequate. This study assesses the utilization of Eye Health Service prevalence (UEHS) among PLWD and associated factors and further quantifies its association with Non-Proliferative Diabetic Retinopathy (NPDR).
A cross-sectional study design with a random sample of 360 PLWD was conducted at Korle-Bu Teaching Hospital, a National Referral Centre in Ghana from May to July 2019. UEHS and DR were the study outcomes. We adopted Poisson and Probit regression analysis to assess factors associated with UEHS over the past year. We employed pairwise and phi correlation (fourfold correlational analysis) to assess the relationship between UEHS and DR (ordinal and binary respectively). Ordered Logistic and Poisson regression were applied to assess the association between the UEHS and DR. Stata 16.1 was used to perform the analyses and a p-value ≤ 0.05 was deemed significant.
The prevalence of UEHS over the past year and DR was 21.7 %(95 %CI = 17.7-26.2) and 65.0 %(95 %CI = 59.9-69.8 respectively. The prevalence of severe NPDR with Clinically Significant Macular Edema (CSME) was 23.9 %(19.8-28.6). Type of diabetes, increasing age, educational level, mode of payment for healthcare services, marital status, years since diagnosis, and current blood glucose significantly influenced UEHS. There was a negative relationship between DR and UEHS (Pairwise and φ correlation were - 20 and - 15 respectively; p < 0.001). Non-UEHS among PLWD doubles the likelihood of experiencing severe NPDR with CSME compared with UEHS among PLWD [aOR(95 %CI) = 2.05(1.03-4.08)]. Meanwhile, the prevalence of DR among patients per non-UEHS was insignificantly higher [12 %; aPR(95 %CI) = 0.89-1.41)] compared with patients who utilized eye care health service.
Most of the PLWD did not utilize the eye health service even once in a year and that was highly influenced by type of diabetes and increasing age. Type 2 diabetes patients and middle age decreased the likelihood of UEHS. There was a negative relationship between DR and UEHS among PLWD and this doubled the likelihood of experiencing severe NPDR with CSME. Structured health education and screening interventions are key to improving UEHS.
在糖尿病患者（PLWD）中，糖尿病视网膜病变的筛查、早期诊断和及时治疗取得了重大进展。然而，在获得眼科专业人员服务不足的中低收入国家，筛查服务仍然是一个挑战。本研究评估了 PLWD 中眼部健康服务利用情况的流行率（UEHS）及其相关因素，并进一步量化了其与非增生性糖尿病视网膜病变（NPDR）的关系。
本研究采用横断面研究设计，于 2019 年 5 月至 7 月在加纳国家转诊中心科勒布教学医院对 360 名 PLWD 进行了随机抽样。UEHS 和 DR 是本研究的结局。我们采用泊松和概率回归分析评估了过去一年中与 UEHS 相关的因素。我们采用配对和 φ 相关（四格相关分析）评估 UEHS 和 DR 之间的关系（分别为有序和二项）。采用有序逻辑回归和泊松回归评估 UEHS 与 DR 之间的关系。Stata 16.1 用于进行分析，p 值≤0.05 被认为具有统计学意义。
过去一年中 UEHS 和 DR 的流行率分别为 21.7%（95%CI=17.7-26.2）和 65.0%（95%CI=59.9-69.8）。严重非增生性糖尿病视网膜病变伴临床显著黄斑水肿（CSME）的患病率为 23.9%（19.8-28.6）。糖尿病类型、年龄增长、教育水平、医疗保健服务支付方式、婚姻状况、诊断后年限和当前血糖水平显著影响 UEHS。DR 与 UEHS 呈负相关（配对和 φ 相关分别为-20 和-15；p<0.001）。与 UEHS 相比，PLWD 中非 UEHS 者发生严重 NPDR 伴 CSME 的可能性增加一倍[aOR（95%CI）=2.05（1.03-4.08）]。同时，与接受眼部保健服务的患者相比，未接受眼部保健服务的患者 DR 的患病率也显著升高[12%；aPR（95%CI）=0.89-1.41]。
大多数 PLWD 即使在一年内也没有使用眼部保健服务，而且这主要受到糖尿病类型和年龄增长的影响。2 型糖尿病患者和中年患者降低了 UEHS 的可能性。PLWD 中 DR 与 UEHS 呈负相关，这使发生严重 NPDR 伴 CSME 的可能性增加一倍。有针对性的健康教育和筛查干预措施是提高 UEHS 的关键。
