影响糖尿病视网膜病变筛查接受度的全球一致性因素：系统评价和荟萃分析。

Factors Affecting Global Adherence for the Uptake of Diabetic Retinopathy Screening: A Systematic Review and Meta-Analysis.

机构信息

From the Research Centre on Health Services and Quality of Life, Aix Marseille University (M.R., L.B., G.F.), Marseille, France; Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University (M.R.), Khoramabad, Iran; Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan (M.R.), Rafsanjan, Iran.

Centre for Health, Performance, and Wellbeing, Anglia Ruskin University (L.S.), Cambridge, United Kingdom.

出版信息

Am J Ophthalmol. 2024 Dec;268:94-107. doi: 10.1016/j.ajo.2024.07.028. Epub 2024 Aug 2.

DOI:10.1016/j.ajo.2024.07.028

PMID:39094991

Abstract

PURPOSE

To evaluate diabetic retinopathy (DR) screening global adherence rate and the association between sociodemographic and clinical variables and adherence rates to DR screening in individuals with diabetes.

DESIGN

Systematic review and meta-analysis.

METHODS

This systematic review was registered with International Prospective Register of Systematic Reviews (ID: CRD42024507035). We conducted a systematic review of relevant literature from inception of databases to February 24, 2024, using electronic databases searches including PubMed, MEDLINE (Ovid), EMBASE, Web of Science, Cochrane CENTRAL, and CDSR and national level DR screening databases through Google searches following PRISMA guidelines. The articles were screened for title and abstract and then for the full-text reports by two independent reviewers and study quality was appraised. Meta-analysis was performed using random effects model to calculate the pooled effects size and 95% confidence interval (CI) of each finding.

RESULTS

Data from a total of 11,383,715 participants from 77 studies and two national websites from 28 countries over five continents were included. Global DR screening adherence rate was 66.9% in high-income countries and 39.3% in low-and-middle-income countries. DR screening adherence rate was lowest in Africa (36.1%) and was highest in Europe (81.3%). Older age (odds ratio [OR] 1.45, 95% CI 1.30-1.62), higher education level (OR = 1.65, 95% CI 1.45-1.78), marriage (OR = 1.42, 95% CI 1.14-1.77), living in an urban area (OR = 1.57, 95% CI 1.08-2.29), higher family income (OR = 1.29, 95% CI 1.24-1.35), having any health insurance (OR = 1.90, 95% CI 1.56-2.31), longer duration of diabetes (OR = 1.57, 95% CI 1.27-1.94), type 2 diabetes (OR = 1.68, 95% CI 1.34-2.10), family history of diabetes (OR = 2.25, 95% CI 1.56-3.25), vision impairment (OR = 2.07, 95% CI 1.43-2.98), history of eye diseases (OR = 1.99, 95% CI 1.36-2.90), insulin treatment (OR = 1.38, 95% CI 1.37-1.39), and good mental health (OR = 1.14, 95% CI 1.04-1.24) were associated with DR screening adherence.

CONCLUSION

This meta-analysis provides key information about which population subgroups may require more targeted intervention and highlights the urgent need to identify ways to improve adherence to DR screening.

REGISTRATION INFORMATION

PROSPERO; ref. no. CRD42024507035, (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=507035).

摘要

目的

评估糖尿病视网膜病变（DR）筛查的全球依从率，并评估社会人口学和临床变量与糖尿病患者 DR 筛查依从率之间的关系。

设计

系统评价和荟萃分析。

方法

本系统评价已在国际前瞻性系统评价注册中心（ID：CRD42024507035）注册。我们按照 PRISMA 指南，从数据库建立到 2024 年 2 月 24 日，对相关文献进行了系统检索，包括电子数据库检索（PubMed、MEDLINE（Ovid）、EMBASE、Web of Science、Cochrane CENTRAL 和 CDSR）和通过谷歌搜索国家层面的 DR 筛查数据库。两名独立评审员对标题和摘要进行筛选，然后对全文报告进行筛选，并评估研究质量。使用随机效应模型进行荟萃分析，计算每个发现的汇总效果大小和 95%置信区间（CI）。

结果

共纳入来自 28 个国家的五个大陆的 77 项研究和两个国家网站的 11383715 名参与者的数据。高收入国家的 DR 筛查依从率为 66.9%，中低收入国家的 DR 筛查依从率为 39.3%。DR 筛查依从率在非洲最低（36.1%），在欧洲最高（81.3%）。年龄较大（比值比[OR]1.45，95%CI1.30-1.62）、较高的教育水平（OR=1.65，95%CI1.45-1.78）、已婚（OR=1.42，95%CI1.14-1.77）、居住在城市地区（OR=1.57，95%CI1.08-2.29）、较高的家庭收入（OR=1.29，95%CI1.24-1.35）、有任何医疗保险（OR=1.90，95%CI1.56-2.31）、糖尿病病程较长（OR=1.57，95%CI1.27-1.94）、2 型糖尿病（OR=1.68，95%CI1.34-2.10）、糖尿病家族史（OR=2.25，95%CI1.56-3.25）、视力障碍（OR=2.07，95%CI1.43-2.98）、眼部疾病史（OR=1.99，95%CI1.36-2.90）、胰岛素治疗（OR=1.38，95%CI1.37-1.39）和良好的心理健康（OR=1.14，95%CI1.04-1.24）与 DR 筛查依从性相关。