Trends in yield and effects of screening intervals during 17 years of a large UK community-based diabetic retinopathy screening programme
Trends in yield and effects of screening intervals during 17 years of a large UK community-based diabetic retinopathy screening programme
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DOI：
10.1111/j.1464-5491.2009.02820.x
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发表时间：
2009-10-01
影响因子：
3.5
通讯作者：
Jones, C. D.
中科院分区：
文献类型：
--
作者：
Misra, A.;Bachmann, M. O.;Jones, C. D.
目的描述筛查计划中风险概况和产量的变化，并调查视网膜病变患病率、筛查间隔和风险因素之间的关系。方法我们分析了主要为 2 型糖尿病患者的人群，在全科实践中进行管理，并在 1990 年至 2006 年间进行了筛查，随访时间长达 17 年，每次筛查次数多达 14 次。我们调查了可转诊或威胁视力的糖尿病视网膜病变 (STDR)、筛查间隔和重复筛查频率之间的关联，同时调整了年龄、持续时间和糖尿病治疗、高血压治疗和周期。结果在 20 788 人的 63 622 次筛查中，16 094 例 (25%) 发现任何视网膜病变，3136 例 (4.9%) 发现可转诊视网膜病变，384 例 (0.60%) 发现视网膜病变标准DR。筛查发现的STDR患病率下降了91%，从1991-1993年的1.7%下降到2006年的0.16%。可转诊视网膜病变的患病率从1991-1993年的2.0%上升到1998-2001年的6.7%，然后下降到2006年的4.7%。与12-18年的筛查间隔相比个月，19-24 个月的筛查间隔与可转诊视网膜病变的风险增加无关[调整后比值比 0.93，94% 置信区间 (CI) 0.82-1.05]，但超过 24 个月的筛查间隔与风险增加相关（比值比 1.56，95% CI 1.41-1.75）。筛查间隔<12个月与可转诊的视网膜病变和STDR的高风险相关。结论随着时间的推移，STDR晚期诊断的风险降低，这可能归因于早期诊断不太严重的视网膜病变、减少危险因素和系统筛查。对于低风险患者，应考虑长达 24 个月的筛查间隔。
AimsTo describe changes in risk profiles and yield in a screening programme and to investigate relationships between retinopathy prevalence, screening interval and risk factors.MethodsWe analysed a population of predominantly Type 2 diabetic patients, managed in general practice, and screened between 1990 and 2006, with up to 17 years' follow-up and up to 14 screening episodes each. We investigated associations between referable or sight-threatening diabetic retinopathy (STDR), screening interval and frequency of repeated screening, whilst adjusting for age, duration and treatment of diabetes, hypertension treatment and period.ResultsOf 63 622 screening episodes among 20 788 people, 16 094 (25%) identified any retinopathy, 3136 (4.9%) identified referable retinopathy and 384 (0.60%) identified STDR. The prevalence of screening-detected STDR decreased by 91%, from 1.7% in 1991-1993 to 0.16% in 2006. The prevalence of referable retinopathy increased from 2.0% in 1991-1993 to 6.7% in 1998-2001, then decreased to 4.7% in 2006. Compared with screening intervals of 12-18 months, screening intervals of 19-24 months were not associated with increased risk of referable retinopathy [adjusted odds ratio 0.93, 94% confidence interval (CI) 0.82-1.05], but screening intervals of more than 24 months were associated with increased risk (odds ratio 1.56, 95% CI 1.41-1.75). Screening intervals of < 12 months were associated with high risks of referable retinopathy and STDR.ConclusionsOver time the risk of late diagnosis of STDR decreased, possibly attributable to earlier diagnosis of less severe retinopathy, decreasing risk factors and systematic screening. Screening intervals of up to 24 months should be considered for lower risk patients.