Geographical disparities in the prevalence of diabetic retinopathy in two contiguous states of South India

AJO International Pub Date : 2024-12-28 DOI:10.1016/j.ajoint.2024.100096

Siddharth Narendran , Meenakshi Ambati , Pricilla J , Sujay Jaju , Rekha Sreedhar , Anju Jose , Joseph Magagnoli , Jaishree Pandian , Karthik Srinivasan , Rodney J Morris , Kim Ramasamy , Narendran Venkatapathy

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Abstract

Purpose

This study aims to examine geographic disparities in the prevalence of Diabetic Retinopathy (DR) and Vision-Threatening Diabetic Retinopathy (VTDR) between two neighboring South Indian states—Tamil Nadu (TN) and Kerala (KL).

Design

A retrospective cross-sectional analysis was conducted, utilizing medical records from five major tertiary hospitals focusing on Type II Diabetes Mellitus (DM) patients aged over 40, from January 2016 to January 2018.

Methods

Data from 213,440 patients with Type II DM were analyzed, including variables such as age, sex, duration of diabetes, and distance traveled to healthcare facilities. Propensity score matching (PSM) was employed to adjust for demographic, clinical, and spatial differences. Falsification tests was performed using Age-Related Macular Degeneration (ARMD) and Macular Hole (MH) as control outcomes.

Results

The prevalence of DR and VTDR was 21.22 % and 10.87 % in the KL cohort, compared to 8.47 % and 3.26 % in the TN cohort, respectively. Adjusted logistic regression, incorporating demographic, clinical, and spatial factors, showed that the KL cohort had an odds ratio of 1.912 (95 % CI: 1.810–2.020) for DR and 2.073 (95 % CI: 1.922–2.236) for VTDR. After PSM for both individual and spatial factors, the odds ratios for the KL cohort were 1.845 (95 % CI: 1.724–1.977) for DR and 1.917 (95 % CI: 1.746–2.105) for VTDR.

Conclusion

This study identifies regional disparities in DR and VTDR between TN and KL. These findings suggest the need for further research and targeted interventions to better understand and address the factors contributing to these disparities.

Precis

This study investigates the significant geographical disparities in the prevalence of Diabetic Retinopathy (DR) between Tamil Nadu and Kerala, two neighboring South Indian states with similar healthcare infrastructures. Analyzing over 200,000 patient records using robust statistical methods, including propensity score matching, the study reveals stark regional differences in DR prevalence. These findings emphasize the need for tailored public health interventions and further research into genetic, socioeconomic, and environmental determinants of diabetic eye diseases.

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印度南部两个相邻邦糖尿病视网膜病变患病率的地理差异

目的本研究旨在研究印度南部两个相邻的邦——泰米尔纳德邦（TN）和喀拉拉邦（KL）之间糖尿病视网膜病变（DR）和威胁视力的糖尿病视网膜病变（VTDR）患病率的地理差异。设计采用回顾性横断面分析，利用五家三级医院2016年1月至2018年1月收治40岁以上2型糖尿病（DM）患者的病历。方法对213440例II型糖尿病患者的数据进行分析，包括年龄、性别、糖尿病病程和前往医疗机构的距离等变量。倾向得分匹配（PSM）用于调整人口统计学、临床和空间差异。以年龄相关性黄斑变性（ARMD）和黄斑孔（MH）作为对照结果进行伪造性检验。结果KL组DR和VTDR患病率分别为21.22%和10.87%，TN组分别为8.47%和3.26%。综合人口学、临床和空间因素的校正logistic回归显示，KL队列DR的优势比为1.912 (95% CI: 1.810-2.020)， VTDR的优势比为2.073 （95% CI: 1.922-2.236）。在个体因素和空间因素均采用PSM后，KL队列DR的优势比为1.845 (95% CI: 1.724-1.977)， VTDR的优势比为1.917 （95% CI: 1.746-2.105）。结论本研究确定了TN和KL在DR和VTDR方面的地区差异，这些发现表明需要进一步研究和有针对性的干预措施，以更好地了解和解决造成这些差异的因素。本研究调查了泰米尔纳德邦和喀拉拉邦之间糖尿病视网膜病变（DR）患病率的显著地理差异，这两个相邻的印度南部州具有相似的医疗基础设施。该研究使用包括倾向评分匹配在内的稳健统计方法分析了20多万例患者记录，揭示了DR患病率的明显地区差异。这些发现强调了有必要进行量身定制的公共卫生干预，并进一步研究糖尿病眼病的遗传、社会经济和环境决定因素。

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