Affiliated Eye Hospital of Nanchang University, Nanchang City, China.
Department of Ophthalmology and Visual Sciences, McGill University, Montréal, Canada.
PLoS One. 2022 Apr 20;17(4):e0266380. doi: 10.1371/journal.pone.0266380. eCollection 2022.
Poor access to existing care for diabetic retinopathy (DR) limits effectiveness of proven treatments.
We examined whether outreach screening in rural China improves equity of access.
DESIGN, SETTING AND PARTICIPANTS: We compared prevalence of female sex, age > = 65 years, primary education or below, and requiring referral care for DR between three cohorts with diabetes examined for DR in neighboring areas of Guangdong, China: passive case detection at secondary-level hospitals (n = 193); persons screened during primary-level DR outreach (n = 182); and individuals with newly- or previously-diagnosed diabetes in a population survey (n = 579). The latter reflected the "ideal" reach of a screening program.
Compared to the population cohort, passive case detection reached fewer women (50·8% vs. 62·3%, p = 0·006), older adults (37·8% vs. 51·3%, p < 0·001), and less-educated persons (39·9% vs. 89·6%, p < 0·001). Outreach screening, compared to passive case detection, improved representation of the elderly (49·5% vs. 37·8%, p = 0·03) and less-educated (70·3% vs. 39·9%, p<0·001). The proportion of women (59.8% vs 62.3%, P>0.300) and persons aged > = 65 years (49.5% vs 51.3%, p = 0.723) in the outreach screening and population cohorts did not differ significantly. Prevalence of requiring referral care for DR was significantly higher in the outreach screening cohort (28·0%) than the population (14·0%) and passive case detection cohorts (7·3%, p<0·001 for both).
Primary-level outreach screening improves access for the poorly-educated and elderly, and removes gender inequity in access to DR care in this setting, while also identifying more severely-affected patients than case finding in hospital.
糖尿病视网膜病变（DR）的现有治疗方法效果不佳，导致其治疗机会有限。
我们研究了在中国农村开展外展筛查是否能改善获得治疗的公平性。
设计、地点和参与者：我们比较了在广东邻近地区接受 DR 检查的三个糖尿病队列中女性比例、年龄≥65 岁、接受小学及以下教育和需要转诊治疗 DR 的比例：二级医院的被动病例检出（n=193）；基层 DR 外展筛查期间接受检查的人员（n=182）；以及人群调查中患有新诊断或既往诊断糖尿病的个体（n=579）。后者反映了筛查计划的“理想”覆盖范围。
与人群队列相比，被动病例检出的女性比例较低（50.8% vs. 62.3%，p=0.006），老年（37.8% vs. 51.3%，p<0.001）和受教育程度较低的个体比例较低（39.9% vs. 89.6%，p<0.001）。与被动病例检出相比，外展筛查改善了老年人（49.5% vs. 37.8%，p=0.03）和受教育程度较低的人群（70.3% vs. 39.9%，p<0.001）的代表性。外展筛查和人群队列中女性（59.8% vs. 62.3%，P>0.300）和年龄≥65 岁的比例（49.5% vs. 51.3%，p=0.723）无显著差异。外展筛查队列中需要转诊治疗 DR 的比例（28.0%）显著高于人群队列（14.0%）和被动病例检出队列（7.3%，p<0.001）。
基层外展筛查改善了受教育程度较低和老年人群获得治疗的机会，并消除了该环境中获得 DR 治疗机会的性别不平等，同时还比医院发现病例更能识别出病情更严重的患者。
