Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China.
<h4>Importance</h4>Poor access to existing care for diabetic retinopathy (DR) limits effectiveness of proven treatments.<h4>Objectives</h4>We examined whether outreach screening in rural China improves equity of access.<h4>Design, setting and participants</h4>We c...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0266380 |
| _version_ | 1797867565022707712 |
|---|---|
| author | Baixiang Xiao Gareth D Mercer Ling Jin Han Lin Lee Tingting Chen Yanfang Wang Yuanping Liu Alastair K Denniston Catherine A Egan Jia Li Qing Lu Ping Xu Nathan Congdon |
| author_facet | Baixiang Xiao Gareth D Mercer Ling Jin Han Lin Lee Tingting Chen Yanfang Wang Yuanping Liu Alastair K Denniston Catherine A Egan Jia Li Qing Lu Ping Xu Nathan Congdon |
| author_sort | Baixiang Xiao |
| collection | DOAJ |
| description | <h4>Importance</h4>Poor access to existing care for diabetic retinopathy (DR) limits effectiveness of proven treatments.<h4>Objectives</h4>We examined whether outreach screening in rural China improves equity of access.<h4>Design, setting and participants</h4>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.<h4>Results</h4>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).<h4>Conclusions and relevance</h4>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. |
| first_indexed | 2024-04-09T23:43:17Z |
| format | Article |
| id | doaj.art-fad332167b5c4cc78012f0f815f58e66 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-09T23:43:17Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-fad332167b5c4cc78012f0f815f58e662023-03-18T05:32:19ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01174e026638010.1371/journal.pone.0266380Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China.Baixiang XiaoGareth D MercerLing JinHan Lin LeeTingting ChenYanfang WangYuanping LiuAlastair K DennistonCatherine A EganJia LiQing LuPing XuNathan Congdon<h4>Importance</h4>Poor access to existing care for diabetic retinopathy (DR) limits effectiveness of proven treatments.<h4>Objectives</h4>We examined whether outreach screening in rural China improves equity of access.<h4>Design, setting and participants</h4>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.<h4>Results</h4>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).<h4>Conclusions and relevance</h4>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.https://doi.org/10.1371/journal.pone.0266380 |
| spellingShingle | Baixiang Xiao Gareth D Mercer Ling Jin Han Lin Lee Tingting Chen Yanfang Wang Yuanping Liu Alastair K Denniston Catherine A Egan Jia Li Qing Lu Ping Xu Nathan Congdon Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China. PLoS ONE |
| title | Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China. |
| title_full | Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China. |
| title_fullStr | Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China. |
| title_full_unstemmed | Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China. |
| title_short | Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China. |
| title_sort | outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural china |
| url | https://doi.org/10.1371/journal.pone.0266380 |
| work_keys_str_mv | AT baixiangxiao outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina AT garethdmercer outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina AT lingjin outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina AT hanlinlee outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina AT tingtingchen outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina AT yanfangwang outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina AT yuanpingliu outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina AT alastairkdenniston outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina AT catherineaegan outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina AT jiali outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina AT qinglu outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina AT pingxu outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina AT nathancongdon outreachscreeningtoaddressdemographicandeconomicbarrierstodiabeticretinopathycareinruralchina |