Global and Regional Prevalence of Diabetic Retinopathy; a Comprehensive Systematic Review and Meta-Analysis of Cross Sectional Studies
46 Pages Posted: 4 Aug 2019More...
Topic: Diabetic retinopathy (DR) prevalence was estimated by different studies but no study address to estimate the global prevalence of that. For this reason; we conducted a systematic search to estimate DR prevalence in different age and sex groups, and to evaluate the determinants of heterogeneity in its prevalence.
Clinical Relevance: Understanding global and regional DR prevalence is critical to planning of eye care services and prioritization of resource allocation to overcoming the burden of DR. Methods: A systematic and comprehensive search from inception to November 2, 2018 was done in international databases, including Scopus, PubMed, Web of Science, Embase, and other data sources without any restriction to find cross sectional studies related to the prevalence of DR. studies conducted in special groups like people presenting to hospitals or clinics has been excluded and the STROBE was used for quality assessment of the studies. The I2 index and random-effects model were applied to investigate heterogeneity and estimate the pooled prevalence; respectively.
Results: Of 5648 studies, 87 articles with a sample size of 541256 individuals and 212497 diabetic patients were analyzed. The estimated pooled prevalence of DR in the diabetic population in general; in female and in male was 28.41% (95% CI: 25.99 to 30.84); 26.10% (95% CI: 3.34 to 28.86) and 28.44% (95% CI: 25.56 to 31.32); respectively and the prevalence of DR showed no inter-gender difference. The heterogeneity of the pooled prevalence according to I2 was 99% (p<0.001). According to the meta-regression results, the variables of WHO region (b: 3.681; p<0.001), age (b: 8.01; p: 0.003), type of DR (b: 18.51; p<0.003), and publication year (b:-0.58; p: 0.001) had a significant correlation with heterogeneity.
Conclusion: One third of diabetic patients suffer from DR, mostly NPDR. DR increased markedly after the age of 60 years, which could be due to the longer duration of diabetes. Age, WHO region, type of DR, and publication year affected the heterogeneity in the prevalence of DR. Our knowledge of the DR global prevalence can be helpful for effective screening and management of DR.
Funding Statement: Noor Research Center for Ophthalmic Epidemiology.
Declaration of Interests: No conflicting relationship exists for any author.
Ethical Approval Statement: Not required.
Keywords: Diabetic retinopathy; Global and regional prevalence; Systematic review; Meta analysis
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