Title of article :
Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis
Author/Authors :
Mahmoudi Nezhad, Golnoush Sadat MPH Department - Shiraz University of Medical Sciences, Shiraz - Poostchi Ophthalmology Research Center - Department of Ophthalmology - Shiraz University of Medical Sciences, Shiraz - Glaucoma Division - Stein Eye Institute - David Geffen School of Medicine - University of California at Los Angeles - Los Angeles - CA - USA , Razeghinejad, Reza Glaucoma Service - Wills Eye Hospital - Philadelphia - PA - USA , Janghorbani, Mohsen Department of Epidemiology and Biostatistics - School of Public Health - Isfahan University of Medical Sciences - Isfahan Endocrine and Metabolism Research Center - Isfahan University of Medical Sciences , Mohamadian, Alireza Student Research Committee - Shiraz University of Medical Sciences - Poostchi Ophthalmology Research Center - Department of Ophthalmology - Shiraz University of Medical Sciences , Jalalpour, Mohammad Hassan Poostchi Ophthalmology Research Center - Department of Ophthalmology - Shiraz University of Medical Sciences , Bazdar, Somaye MPH Department - Shiraz University of Medical Sciences, Shiraz - Poostchi Ophthalmology Research Center - Department of Ophthalmology - Shiraz University of Medical Sciences , Salehi, Alireza MPH Department - Shiraz University of Medical Sciences, Shiraz , Molavi Vardanjani, Hossein MPH Department - Shiraz University of Medical Sciences, Shiraz
Abstract :
Purpose: To estimate the pooled prevalence and incidence of diabetic retinopathy (DR) in Iran and to investigate their correlations with the Human Development Index (HDI), healthcare access (i.e., density of specialists and sub-specialists), and methodological issues.
Methods: Electronic databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and
local databases were searched for cohort and cross-sectional studies published prior to January 2018.
Prevalence and incidence rates of DR were extracted from January 2000 to December 2017 and random
effects models were used to estimate pooled effect sizes. The Joanna Briggs Institute critical appraisal tool
was applied for quality assessment of eligible studies.
Results: A total of 55,445 participants across 33 studies were included. The pooled prevalence (95% CI) of
DR in diabetic clinics (22 studies), eye clinics (4 studies), and general population (7 studies) was 31.8% (24.5
to 39.2), 57.8% (50.2 to 65.3), and 29.6% (22.6 to 36.5), respectively. It was 7.4% (3.9 to 10.8) for proliferative
DR and 7.1% (4.9 to 9.4) for clinically significant macular edema. The heterogeneity of individual estimates
of prevalence was highly significant. HDI (𝑃 < 0.001), density of specialists (𝑃 = 0.004), subspecialists (𝑃 <
0.001), and sampling site (𝑃 = 0.041) were associated with heterogeneity after the adjustment for type of DR,
duration of diabetes, study year, and proportion of diabetics with controlled HbA1C.
Conclusion: Human development and healthcare access were correlated with the prevalence of DR. Data
were scarce on the prevalence of DR in less developed provinces. Participant recruitment in eye clinics might overestimate the prevalence of DR.
Keywords :
Access to Health Care , Diabetic Retinopathy , Epidemiology , Human Development , Iran
Journal title :
Journal of Ophthalmic and Vision Research
