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Diabetes and endocrinology
Research
Population trends in the 10-year incidence and prevalence of diabetic retinopathy in the UK: a cohort study in the Clinical Practice Research Datalink 2004–2014
  1. Rohini Mathur1,
  2. Krishnan Bhaskaran1,
  3. Emma Edwards2,
  4. Helen Lee2,
  5. Nishi Chaturvedi3,
  6. Liam Smeeth1,
  7. Ian Douglas1
  1. 1Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Royal National Institute of Blind People, London, UK
  3. 3Institute of Cardiovascular Science, UCL, London, UK
  1. Correspondence to Dr Rohini Mathur; Rohini.mathur{at}lshtm.ac.uk

Abstract

Objectives To describe trends in the incidence and prevalence of diabetic retinopathy (DR) in the UK by diabetes type, age, sex, ethnicity, deprivation, region and calendar year.

Design Cohort study using the Clinical Practice Research Datalink (CPRD).

Setting UK primary care.

Participants 7.7 million patients ≥12 contributing to the CPRD from 2004 to 2014.

Primary and secondary outcome measures Age-standardised prevalence and incidence of diabetes, DR and severe DR (requiring photocoagulation) by calendar year and population subgroup. Relative risk of developing DR and severe DR by population subgroup.

Results The prevalence of DR was 48.4% in the population type 1 diabetes mellitus (T1DM) (14 846/30 657) and 28.3% (95 807/338 390) in the population with type 2 diabetes mellitus (T2DM). Prevalence of DR remained stable in people with T2DM and decreased in people with T1DM. Screening for DR increased over time for patients with T2DM and remained static for patients with T1DM Incidence of DR increased in parallel with the incidence of T2DM in both diabetic populations. Among patients with T2DM, relative risk of DR varied significantly by region, was increased for older age groups and in men compared with women, with risk of severe DR increased in South Asian groups and more deprived groups. Relative risk of DR for patients with T1DM varied by age and region, but not by gender, ethnic group or deprivation.

Conclusions This is the largest study to date examining the burden of DR in the UK. Regional disparities in incidence may relate to differences in screening delivery and disease ascertainment. Evidence that deprivation and ethnicity are associated with a higher risk of severe DR highlights a significant potential health inequality. Findings from this study will have implications for professionals working in the diabetes and sight loss sectors, particularly to inform approaches for diagnosis of retinopathy and campaigning to better tackle the disease for at risk groups.

  • EPIDEMIOLOGY
  • PRIMARY CARE
  • PUBLIC HEALTH

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2016-014444

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    Footnotes

    • Contributors HL and EE provided the original remit for the study. The study was conceived and supervised by ID. ID and RM designed the study. RM extracted the data, conducted the statistical analysis and drafted the manuscript. EE, HL, LS, KB and NS contributed to interpretation of the findings, further drafts and approved the final manuscript. ID is guarantor.

    • Funding Funding was provided by the RNIB for the salary of RM for the completion of this project. KB holds a Sir Henry Dale fellowship jointly funded by the Wellcome Trust and the Royal Society (107731/Z/15/Z). LS is supported by a Wellcome Trust Senior Research Fellowship in Clinical Science [098504/Z/12/Z].

    • Disclaimer Funders were not involved in the study design, data collection or analysis. Funders were involved in generating the research question and gave comments on the final manuscript.

    • Competing interests None declared.

    • Ethics approval The prespecified study protocol was approved by the Independent Scientific Advisory Committee for MHRA Database Research (ISAC). Approval was also received from the London School of Hygiene and Tropical Medicine ethics committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data were obtained from the Clinical Practice Research Datalink (CPRD). CPRD is a research service that provides primary care and linked data for public health research. CPRD data governance and our own license to use CPRD data do not allow us to distribute or make available patient data directly to other parties. Researchers can apply for data access at http://www.cprd.com, and must have their study protocol approved by the Independent Scientific Advisory Committee for MHRA database research (details at http://www.cprd.com/isac).