Is diabetic retinopathy screening worthwhile among people first diagnosed with diabetes at older ages? A cohort study of Norfolk diabetic retinopathy screening programme

Brodie, James, Misra, Aseema, Jones, Colin D., Jenkins, Chrystal and Bachmann, Max O. ORCID: https://orcid.org/0000-0003-1770-3506 (2024) Is diabetic retinopathy screening worthwhile among people first diagnosed with diabetes at older ages? A cohort study of Norfolk diabetic retinopathy screening programme. Diabetic Medicine, 41 (2). ISSN 0742-3071

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Abstract

Aims: England's Diabetic Eye Disease Screening Programme offers screening to every resident over age 12 with diabetes, starting as soon as possible after diagnosis and repeated annually. People first diagnosed with diabetes at older ages have shorter life expectancy and therefore may be less likely to benefit from screening and treatment. To inform decisions about whether diabetic eye screening policy should be stratified by age, we investigated the probability of receiving treatment according to age at first screening episode. Methods: This was a cohort study of participants in the Norfolk Diabetic Retinopathy Screening Programme from 2006 to 2017, with individuals' programme data linked to hospital treatment and death data recorded up to 2021. We estimated and compared the probability, annual incidence and screening costs of receiving retinal laser photocoagulation or intravitreal injection and of death, in age groups defined by age at first screening episode. Results: The probability of death increased with increasing age at diagnosis, while the probability of receiving either treatment decreased with increasing age. The estimated cost of screening per person who received either or both treatments was £18,608 among all participants, increasing with age up to £21,721 in those aged 70–79 and £26,214 in those aged 80–89. Conclusions: Diabetic retinopathy screening is less effective and less cost-effective with increasing age at diagnosis of diabetes, because of the increasing probability of death before participants develop sight-threatening diabetic retinopathy and can benefit from treatment. Upper age limits on entry into screening programmes or risk stratification in older age groups may, therefore, be justifiable.

Item Type:	Article
Additional Information:	ACKNOWLEDGEMENTS: The British Diabetes Association (now Diabetes UK) and the Allied Dunbar Foundation funded the retinal camera and screening van with which the screening program was started. The Central Norfolk screening program receives financial support from the Norwich and Norfolk Diabetes Trust. The authors are grateful to the photographers, graders and administration staff of the Central Norfolk Diabetic Retinopathy Screening Service. Maggie Flatman, Norfolk Diabetes Trust, helped set up the service and commissioned the database.
Uncontrolled Keywords:	sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Centres > Population Health
Depositing User:	LivePure Connector
Date Deposited:	12 Oct 2023 00:42
Last Modified:	20 Jan 2024 01:34
URI:	https://ueaeprints.uea.ac.uk/id/eprint/93266
DOI:	10.1111/dme.15164

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