Proportion of people with diabetic retinopathy and macular oedema varies by ethnicity in a tertiary retinal clinic in Australia: findings from the Liverpool Eye and Diabetes Study (LEADS)

Abstract

ObjectiveThere are limited data on the influence of ethnicity on diabetic retinopathy (DR). We sought to determine the distribution of DR by ethnic group in Australia.DesignClinic-based cross-sectional study.SettingParticipants with diabetes in a defined geographical region of Sydney, Australia, who attended a tertiary retina referral clinic.ParticipantsThe study recruited 968 participants.InterventionParticipants underwent a medical interview and retinal photography and scanning.Primary outcome measuresDR was defined from two-field retinal photographs. Diabetic macular oedema (DMO) was defined from spectral domain optical coherence tomography (OCT-DMO). The main outcomes were any DR, proliferative DR (PDR), clinically significant macular oedema (CSME), OCT-DMO and sight-threatening DR (STDR).ResultsThere was high proportion of any DR (52.3%), PDR (6.3%), CSME (19.7%), OCT-DMO (28.9%) and STDR (31.5%) in people attending a tertiary retinal clinic. Participants of Oceanian ethnicity had the highest proportion of any DR and STDR (70.4% and 48.1%, respectively), while the lowest proportion was in participants of East Asian ethnicity (38.3% and 15.8%, respectively). Proportion of any DR and STDR in Europeans was 54.5% and 30.3%, respectively. Independent predictive factors for diabetic eye disease were ethnicity, longer duration of diabetes, higher glycated haemoglobin and higher blood pressure. Even after adjusting for risk factors, Oceanian ethnicity remained associated with twofold higher odds of any DR (adjusted OR 2.10, 95% CI 1.10 to 4.00) and all other forms of DR including STDR (adjusted OR 2.22, 95% CI 1.19 to 4.15).ConclusionIn people attending a tertiary retinal clinic, the proportion of people with DR varies among ethnic groups. The high proportion in persons of Oceanian ethnicity suggests a need for targeted screening of this at-risk group. In addition to traditional risks factors, ethnicity may be an additional independent predictor of DR.

Synergistic Feature Engineering and Ensemble Learning for Early Chronic Disease Prediction

“…Efficient evaluation of AI systems in healthcare requires a thorough examination of their performance across diverse datasets [65], [66]. Due to the diverse nature of disease prevalence, manifestations, and risk factors across regions and ethnicities, there exists a potential for biased or inaccurate predictions when models are trained on limited data from underrepresented populations.…”

Clinically significant macular edema in an underserved population: Association with demographic factors and hemoglobin A1c

“…are often not large enough to permit logistic regression and rely on appropriate sampling to compare results across demographic variables. 7,9,13,14 We believe that the present study is one of the very few studies comparing the prevalence of suspected clinically significant macular edema from exudates across these major ethnic groups.…”

“…The prevalence of clinically significant macular edema is influenced by demographic factors and ethnic group, with an estimated pooled prevalence rate of 4.07% among individuals with diabetes 6–9 . Clinically significant macular edema prevalence is significantly greater for African Americans compared with non-Hispanic Caucasians 7,10 .…”

“…Most previous studies are limited to a subset of the most prevalent ethnic groups, usually omitting Asians, and a cross-sectional design that sometimes incorporates different geographic locations for different groups. Sample sizes are often not large enough to permit logistic regression and rely on appropriate sampling to compare results across demographic variables 7,9,13,14 . We believe that the present study is one of the very few studies comparing the prevalence of suspected clinically significant macular edema from exudates across these major ethnic groups.…”

“…The prevalence of clinically significant macular edema is influenced by demographic factors and ethnic group, with an estimated pooled prevalence rate of 4.07% among individuals with diabetes. [6][7][8][9] Clinically significant macular edema prevalence is significantly greater for African Americans compared with non-Hispanic Caucasians. 7,10 Although the ethnic disparities for the presence of diabetic retinopathy and clinically significant macular edema are well established, there is also a strong interaction between the social and demographic factors such as age, sex, dietary habits, education, income, and access to health care that can alter the individual's risk of having clinically significant macular edema and subsequent risk of vision loss.…”