Journal List > J Korean Ophthalmol Soc > v.50(9) > 1008356

Shin and Chi: Fundus Examination Rate in Diabetics and the Public Health Factors Associated With Fundus Examination Rate

Abstract

Purpose

To investigate the fundus examination rate in diabetic patients and the public health factors associated with the fundus examination rate.

Methods

We analyzed the results of the third Korean National Health and Nutrition Examination Survey. We investigated the fundus examination rate in patients who had diabetes mellitus for more than 3 months during the previous year and determined the relationship of public health factors with the fundus examination rate.

Results

In all 547 patients (38.1%) received the fundus examination out of 1,437 total patients with diabetes mellitus. We found that many public health factors influenced the higher fundus examination rate, including patients who were residents in urban areas, women, office workers, university graduates, patients with a higher family income or more than 5 years duration of diabetes mellitus, patients with current insulin treatment, treatment of diabetes mellitus, education about diabetes mellitus, subjective visual problems or subjective health problems. However, age, marital status, health insurance and residential district did not influence the fundus examination rate.

Conclusions

The Korean National Health and Nutrition Examination Survey is the largest health survey in Korea. This study is meaningful as a population-based study, not a clinic-based cross-sectional study and it suggests the basic data for improving the fundus examination rate in diabetes mellitus patients.

References

1. Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: Estimates and projections to the year 2010. Diabetic Med. 1997; 14:S1–85.
crossref
2. American Diabetic Association. Diabetic Retinopathy. Diabetes Care. 2000; 23:S73–6.
3. Klein R, Klein BE, Moss SE. The Wisconsin Epidemiological Study of Diabetic Retinopathy: a review. Diabetic Metab Rev. 1989; 5:559–70.
crossref
4. Kwon HS, Kim KW, Kim DJ, et al. Diabetes mellitus epidemiologic study in Korea. 2005. Available at:. http://www.diabetes.or.kr.
5. American College of physicians, American Diabetes Association, American Academy of Ophthalmology. Screening guideline for diabetic retinopathy. Ann Intern Med. 1992; 116:683–5.
6. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. Early Treatment Diabetic Retinopathy Study. Report Number 9. Ophthalmology. 1991; 98:766–85.
7. Zoega GM, Gunnarsdottir T, Bjornsdottir S, et al. Screening compliance and visual outcome in diabetes. Acta Ophthalmol Scand. 2005; 83:687–90.
crossref
8. Kim HK, Oh TS, Lee SM, Lee JB. The initial fundus examination and severity of diabetic retinopathy at a primary eye clinic. J Korean Ophthalmol Soc. 2005; 46:982–8.
9. Kim JS, Chin HS, Moon YS. A clinical analysis and referral rate on diabetic retinopathy in diabetic patients referred for eye examination at a tertiary hospital. J Korean Ophthalmol Soc. 2003; 44:1093–101.
10. Park MY, Ohn YH, Shin HH. Clinical analysis diabetic retinopathy for diabetics who were consulted from medical department. J Korean Ophthalmol Soc. 1994; 35:1068–72.
11. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025-Prevalence, numerical estimates, and projects. Diabetes Care. 1998; 21:1414–31.
12. Klein R, Klein BE, Moss SE, Linton KL. The Beaver dam eye study: Retinopathy in adults with newly discovered and previously diagnosed diabetes mellitus. Ophthalmology. 1992; 99:58–60.
13. Stolk RP, Vingerling JR, de Jong PT, et al. Retinopathy, glucose and insulin in an elderly population: the Rotterdam study. Diabetes. 1995; 44:11–5.
crossref
14. Mitchell P, Smith W, Wang JJ, Attebo K. Prevalence of diabetic retinopathy in an older community: the Blue Mountain Eye Study. Ophthalmology. 1998; 105:406–11.
15. Mitchell P, Moffitt P. Update and implications from the New-castle diabetic retinopathy study. Aust N Z J Ophthalmol. 1990; 18:13–7.
crossref
16. Narendran V, John RK, Raghuram A, et al. Diabetic retinopathy among self reported diabetics in southern India: a population based assessment. Br J Ophthalmol. 2002; 86:1014–8.
crossref
17. Nagi DK, Pettitt DJ, Bennett PH, et al. Diabetic Retinopathy assessed by fundus photography in pima indians with impaired glucose tolerance and NIDDM. Diabetic Med. 1997; 14:449–56.
crossref
18. American Academy of Ophthalmology Retina Panel. Preferred practice pattern guidelines. Diabetic Retinopathy. San Francisco, CA: American Academy of Ophthalmology;2008. Available at:. http://www.aao.org.
19. Dervan E, Lillis D, Flynn L, et al. Factors that influence the patient uptake of diabetic retinopahty screening. Ir J Med Sci. 2008; 177:303–8.
20. Jinaan BS, Donald SF, Janis Yao. Factors associated with followup eye examinations among persons with diabetes. Retina. 2008; 28:195–200.
21. Mukamel DB, Bresnick GH, Wang Q, Dickey CF. Barriers to compliance with screening guidelines for diabetic retinopathy. Ophthalmic Epidemiol. 1999; 6:61–72.
crossref
22. Moss SE, Klein R, Klein BE. Factors associated with having eye examinations in persons with diabetes. Ach Fam Med. 1995; 4:529–34.
crossref
23. Fred Ramsey, Ann Ussery-Hall, Danyael Garcia, et al. Prevalence of selected risk behaviors and chronic diseases - Behavioral Risk Factor Surveillance System (BRFSS), 39 Steps Communities, United States, 2005. MMWR Surveill Summ. 2008; 57:1–20.
24. Jin JH, Lee SJ, Lee HS, Kim SD. Prognostic factors of visual acuity in diabetes mellitus. J Korean Ophthalmol Soc. 2006; 47:755–62.

Figure 1.
Distribution of fundus examination rate classified by districts.
jkos-50-1319f1.tif
Table 1.
Fundus examination rate classified by major public health factors
    Number of participants (%) Number of nonparticipants (%) Total (%) p value
Sex Male 260 (35.7%) 469 (64.3%) 729 (100%)  
  Female 293 (41.6%) 411 (58.4%) 704 (100%) 0.021
  Total 553 (38.6%) 880 (61.4%) 1,433 (100%)  
Age 20s 6 (46.2%) 7 (53.8%) 13 (100%)  
  30s 12 (22.6%) 41 (77.4%) 53 (100%)  
  40s 83 (39.7%) 126 (60.3%) 209 (100%)  
  50s 142 (38.5%) 227 (61.5%) 369 (100%) 0.301
  60s 177 (38.7%) 280 (61.3%) 457 (100%)  
  70s≤ 133 (40.1%) 199 (59.9%) 332 (100%)  
  Total 553 (38.6%) 880 (61.4%) 1,433 (100%)  
Residence Urban area 431 (40.1%) 644 (59.9%) 1,075 (100%)  
  Rural area 122 (34.1%) 236 (65.9%) 358 (100%) 0.043
  Total 553 (38.6%) 880 (61.4%) 1,433 (100%)  
Employment Office workers 42 (42.0%) 58 (58.0%) 100 (100%)  
  Production workers 164 (33.6%) 324 (66.4%) 488 (100%) 0.020
  The others 347 (41.1%) 498 (58.9%) 845 (100%)  
  Total 553 (38.6%) 880 (61.4%) 1,433 (100%)  
Educational status Elementary school 247 (35.8%) 442 (64.2%) 689 (100%)  
  Middle school 91 (39.2%) 141 (60.8%) 232 (100%)  
  High school 133 (39.5%) 204 (60.5%) 337 (100%) 0.011
  University 82 (47.1%) 92 (52.9%) 174 (100%)  
  Total 553 (38.6%) 879 (61.4%) 1,432 (100%)  
Family income <A million won 116 (33.1%) 234 (66.9%) 350 (100%)  
  A million∼2 million won 80 (38.5%) 128 (61.5%) 208 (100%)  
  2 million∼3 million won 48 (35.8%) 86 (64.2%) 134 (100%) 0.010
  3 million won≤ 82 (45.8%) 97 (54.2%) 179 (100%)  
  Total 326 (37.4%) 545 (62.6%) 871 (100%)  
Marital status Single 9 (25.7%) 26 (74.3%) 35 (100%)  
  Married 402 (39.6%) 612 (60.4%) 1,014 (100%) 0.188
  Bereaved, divorced, separates 142 (37.0%) 242 (63.0%) 384 (100%)  
  Total 553 (38.6%) 880 (61.4%) 1,433 (100%)  
Durarion of diabetes <5years 196 (28.2%) 498 (71.8%) 694 (100%)  
  5 years≤ 357 (48.3%) 382 (51.7%) 739 (100%) 0.000
  Total 553 (38.6%) 880 (61.4%) 1,433 (100%)  
Treatment of diabetes Yes 516 (45.7%) 613 (54.3%) 1,129 (100%)  
  No 37 (12.2%) 267 (87.8%) 304 (100%) 0.000
  Total 553 (38.6%) 880 (61.4%) 1,433 (100%)  
Insulin treatment Yes 73 (64.0%) 41 (36.0%) 114 (100%)  
  No 479 (36.3%) 839 (63.7%) 1,318 (100%) 0.000
  Total 552 (38.5%) 880 (61.5%) 1,432 (100%)  
Education of diabetes Yes 209 (58.5%) 148 (41.5%) 357 (100%)  
  No 343 (32.1%) 725 (67.9%) 1,068 (100%) 0.000
  Total 552 (38.7%) 873 (61.3%) 1,425 (100%)  
Subjective visual disturbance Good 273 (34.2%) 526 (65.8%) 799 (100%)  
  Moderate 208 (41.8%) 290 (58.2%) 498 (100%) 0.000
  Poor 72 (53.3%) 63 (46.7%) 135 (100%)  
  Total 553 (38.6%) 879 (61.4%) 1,432 (100%)  
Subjective health status Good 50 (31.1%) 111 (68.9%) 161 (100%)  
  Moderate 153 (35.5%) 278 (64.5%) 431 (100%) 0.003
  Poor 350 (41.7%) 490 (58.3%) 840 (100%)  
  Total 553 (38.6%) 879 (61.4%) 1,432 (100%)  
Health insurance Nation-paid 206 (35.7%) 371 (64.3%) 557 (100%)  
  Employer-paid 296 (58.8%) 422 (58.8%) 718 (100%) 0.122
  Medical-aid 51 (37.5%) 85 (62.5%) 136 (100%)  
  Total 553 (38.6%) 878 (61.4%) 1,431 (100%)  
Table 2.
The odd ratio of the fundus examination rate classified by the significant public health factors
    Odd Ratio 95% CI p value
Sex Female / Male 1.922 1.034∼3.572 0.039
Educational status Middle school / Elementary 1.371 0.850∼2.210 0.195
  High school / Elementary 1.427 0.910∼2.236 0.121
  University / Elementary 2.252 1.290∼3.931 0.004
Treatment of DM Do / Do not 5.986 3.705∼9.671 0.000
Education for DM Do / Do not 2.351 1.656∼3.338 0.000
Subjective visual A little / No 1.558 1.090∼2.226 0.015
disturbance Much / No 2.380 1.361∼4.161 0.002

Statically significant.

TOOLS
Similar articles