Geographic variation in diabetic retinopathy screening within the Veterans Health Administration
Diabetic retinopathy (DR) remains the leading cause of vision impairment among working-age adults in the United States. The Veterans Health Administration (VA) supplemented its DR screening efforts with teleretinal imaging in 2006. Despite its scale and longevity, no national data on the VA’s screen...
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| Veröffentlicht in: | Primary care diabetes 2023-10, Vol.17 (5), p.429-435 |
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| creator | Davis, Melanie Snider, Molly J.E. Hunt, Kelly J. Medunjanin, Danira Neelon, Brian Maa, April Y. |
| description | Diabetic retinopathy (DR) remains the leading cause of vision impairment among working-age adults in the United States. The Veterans Health Administration (VA) supplemented its DR screening efforts with teleretinal imaging in 2006. Despite its scale and longevity, no national data on the VA’s screening program exists since 1998. Our objective was to determine the influence of geography on diabetic retinopathy screening adherence.
Setting: VA national electronic medical records. Study Population: A national cohort of 940,654 veterans with diabetes (defined as two or more diabetes ICD-9 codes (250.xx)) without a history of DR. Exposures: 125 VA Medical Center catchment areas, demographics, comorbidity burden, mean HbA1c levels, medication use and adherence, as well as utilization and access metrics. Main Outcome Measure: Screening for diabetic retinopathy within the VA medical system within a 2-year period.
Within a 2-year time frame 74 % of veterans without a history of DR received retinal screenings within the VA system. After adjustment for age, gender, race-ethnic group, service-connected disability, marital status, and the van Walraven Elixhauser comorbidity score, the prevalence of DR screening varied by VA catchment area with values ranging from 27 % to 86 %. These differences persisted after further adjusting for mean HbA1c level, medication use and adherence as well as utilization and access metrics.
The wide variability in DR screening across 125 VA catchment areas indicates the presence of unmeasured determinants of DR screening. These results are relevant to clinical decision making in DR screening resource allocation.
•What is the influence of space on diabetic retinopathy screening adherence?•We adjusted for demographics, comorbidities, disease burden, and healthcare access metrics.•Screening adherence varied from 27 % to 86 % by catchment area.•Unexplained variation driven by geography or unmeasured determinants. |
| doi_str_mv | 10.1016/j.pcd.2023.06.004 |
| format | Article |
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Setting: VA national electronic medical records. Study Population: A national cohort of 940,654 veterans with diabetes (defined as two or more diabetes ICD-9 codes (250.xx)) without a history of DR. Exposures: 125 VA Medical Center catchment areas, demographics, comorbidity burden, mean HbA1c levels, medication use and adherence, as well as utilization and access metrics. Main Outcome Measure: Screening for diabetic retinopathy within the VA medical system within a 2-year period.
Within a 2-year time frame 74 % of veterans without a history of DR received retinal screenings within the VA system. After adjustment for age, gender, race-ethnic group, service-connected disability, marital status, and the van Walraven Elixhauser comorbidity score, the prevalence of DR screening varied by VA catchment area with values ranging from 27 % to 86 %. These differences persisted after further adjusting for mean HbA1c level, medication use and adherence as well as utilization and access metrics.
The wide variability in DR screening across 125 VA catchment areas indicates the presence of unmeasured determinants of DR screening. These results are relevant to clinical decision making in DR screening resource allocation.
•What is the influence of space on diabetic retinopathy screening adherence?•We adjusted for demographics, comorbidities, disease burden, and healthcare access metrics.•Screening adherence varied from 27 % to 86 % by catchment area.•Unexplained variation driven by geography or unmeasured determinants.</description><identifier>ISSN: 1751-9918</identifier><identifier>EISSN: 1878-0210</identifier><identifier>DOI: 10.1016/j.pcd.2023.06.004</identifier><identifier>PMID: 37419770</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adult ; Diabetes Mellitus ; Diabetic Retinopathy - diagnosis ; Diabetic Retinopathy - epidemiology ; Diabetic retinopathy screening ; Geographic determinants of health ; Glycated Hemoglobin ; Health Facilities ; Humans ; Mass Screening - methods ; United States - epidemiology ; Veterans ; Veterans Health</subject><ispartof>Primary care diabetes, 2023-10, Vol.17 (5), p.429-435</ispartof><rights>2023 Primary Care Diabetes Europe</rights><rights>Copyright © 2023 Primary Care Diabetes Europe. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-98efdb35cb8ebd4bce6becb734a2bc2fe17be19ba0a1e7381c6793907c5ddaa23</citedby><cites>FETCH-LOGICAL-c353t-98efdb35cb8ebd4bce6becb734a2bc2fe17be19ba0a1e7381c6793907c5ddaa23</cites><orcidid>0000-0001-7197-2518 ; 0000-0002-8929-6033</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37419770$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Davis, Melanie</creatorcontrib><creatorcontrib>Snider, Molly J.E.</creatorcontrib><creatorcontrib>Hunt, Kelly J.</creatorcontrib><creatorcontrib>Medunjanin, Danira</creatorcontrib><creatorcontrib>Neelon, Brian</creatorcontrib><creatorcontrib>Maa, April Y.</creatorcontrib><title>Geographic variation in diabetic retinopathy screening within the Veterans Health Administration</title><title>Primary care diabetes</title><addtitle>Prim Care Diabetes</addtitle><description>Diabetic retinopathy (DR) remains the leading cause of vision impairment among working-age adults in the United States. The Veterans Health Administration (VA) supplemented its DR screening efforts with teleretinal imaging in 2006. Despite its scale and longevity, no national data on the VA’s screening program exists since 1998. Our objective was to determine the influence of geography on diabetic retinopathy screening adherence.
Setting: VA national electronic medical records. Study Population: A national cohort of 940,654 veterans with diabetes (defined as two or more diabetes ICD-9 codes (250.xx)) without a history of DR. Exposures: 125 VA Medical Center catchment areas, demographics, comorbidity burden, mean HbA1c levels, medication use and adherence, as well as utilization and access metrics. Main Outcome Measure: Screening for diabetic retinopathy within the VA medical system within a 2-year period.
Within a 2-year time frame 74 % of veterans without a history of DR received retinal screenings within the VA system. After adjustment for age, gender, race-ethnic group, service-connected disability, marital status, and the van Walraven Elixhauser comorbidity score, the prevalence of DR screening varied by VA catchment area with values ranging from 27 % to 86 %. These differences persisted after further adjusting for mean HbA1c level, medication use and adherence as well as utilization and access metrics.
The wide variability in DR screening across 125 VA catchment areas indicates the presence of unmeasured determinants of DR screening. These results are relevant to clinical decision making in DR screening resource allocation.
•What is the influence of space on diabetic retinopathy screening adherence?•We adjusted for demographics, comorbidities, disease burden, and healthcare access metrics.•Screening adherence varied from 27 % to 86 % by catchment area.•Unexplained variation driven by geography or unmeasured determinants.</description><subject>Adult</subject><subject>Diabetes Mellitus</subject><subject>Diabetic Retinopathy - diagnosis</subject><subject>Diabetic Retinopathy - epidemiology</subject><subject>Diabetic retinopathy screening</subject><subject>Geographic determinants of health</subject><subject>Glycated Hemoglobin</subject><subject>Health Facilities</subject><subject>Humans</subject><subject>Mass Screening - methods</subject><subject>United States - epidemiology</subject><subject>Veterans</subject><subject>Veterans Health</subject><issn>1751-9918</issn><issn>1878-0210</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LxDAQhoMouq7-AC_So5fWpGmbFE-y-AWCF_Ua8zG1WbppTbKK_96sqx69zAzDMy_Mg9AJwQXBpDlfFpM2RYlLWuCmwLjaQTPCGc9xSfBumllN8rYl_AAdhrDEuCGUs310QFlFWsbwDL3cwPjq5dRbnb1Lb2W0o8usy4yVCmLa-lTdOMnYf2ZBewBn3Wv2YWOfqNhD9gwRvHQhuwU5xD67NCvrbIj-O-sI7XVyCHD80-fo6frqcXGb3z_c3C0u73NNaxrzlkNnFK214qBMpTQ0CrRitJKl0mUHhCkgrZJYEmCUE92wlraY6doYKUs6R2fb3MmPb2sIUaxs0DAM0sG4DqLktC45aTBNKNmi2o8heOjE5O1K-k9BsNiIFUuRxIqNWIEbkcSmm9Of-LVagfm7-DWZgIstAOnJdwteBG3BaTDWg47CjPaf-C8uhYvT</recordid><startdate>202310</startdate><enddate>202310</enddate><creator>Davis, Melanie</creator><creator>Snider, Molly J.E.</creator><creator>Hunt, Kelly J.</creator><creator>Medunjanin, Danira</creator><creator>Neelon, Brian</creator><creator>Maa, April Y.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7197-2518</orcidid><orcidid>https://orcid.org/0000-0002-8929-6033</orcidid></search><sort><creationdate>202310</creationdate><title>Geographic variation in diabetic retinopathy screening within the Veterans Health Administration</title><author>Davis, Melanie ; Snider, Molly J.E. ; Hunt, Kelly J. ; Medunjanin, Danira ; Neelon, Brian ; Maa, April Y.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-98efdb35cb8ebd4bce6becb734a2bc2fe17be19ba0a1e7381c6793907c5ddaa23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Diabetes Mellitus</topic><topic>Diabetic Retinopathy - diagnosis</topic><topic>Diabetic Retinopathy - epidemiology</topic><topic>Diabetic retinopathy screening</topic><topic>Geographic determinants of health</topic><topic>Glycated Hemoglobin</topic><topic>Health Facilities</topic><topic>Humans</topic><topic>Mass Screening - methods</topic><topic>United States - epidemiology</topic><topic>Veterans</topic><topic>Veterans Health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Davis, Melanie</creatorcontrib><creatorcontrib>Snider, Molly J.E.</creatorcontrib><creatorcontrib>Hunt, Kelly J.</creatorcontrib><creatorcontrib>Medunjanin, Danira</creatorcontrib><creatorcontrib>Neelon, Brian</creatorcontrib><creatorcontrib>Maa, April Y.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Primary care diabetes</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Davis, Melanie</au><au>Snider, Molly J.E.</au><au>Hunt, Kelly J.</au><au>Medunjanin, Danira</au><au>Neelon, Brian</au><au>Maa, April Y.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Geographic variation in diabetic retinopathy screening within the Veterans Health Administration</atitle><jtitle>Primary care diabetes</jtitle><addtitle>Prim Care Diabetes</addtitle><date>2023-10</date><risdate>2023</risdate><volume>17</volume><issue>5</issue><spage>429</spage><epage>435</epage><pages>429-435</pages><issn>1751-9918</issn><eissn>1878-0210</eissn><abstract>Diabetic retinopathy (DR) remains the leading cause of vision impairment among working-age adults in the United States. The Veterans Health Administration (VA) supplemented its DR screening efforts with teleretinal imaging in 2006. Despite its scale and longevity, no national data on the VA’s screening program exists since 1998. Our objective was to determine the influence of geography on diabetic retinopathy screening adherence.
Setting: VA national electronic medical records. Study Population: A national cohort of 940,654 veterans with diabetes (defined as two or more diabetes ICD-9 codes (250.xx)) without a history of DR. Exposures: 125 VA Medical Center catchment areas, demographics, comorbidity burden, mean HbA1c levels, medication use and adherence, as well as utilization and access metrics. Main Outcome Measure: Screening for diabetic retinopathy within the VA medical system within a 2-year period.
Within a 2-year time frame 74 % of veterans without a history of DR received retinal screenings within the VA system. After adjustment for age, gender, race-ethnic group, service-connected disability, marital status, and the van Walraven Elixhauser comorbidity score, the prevalence of DR screening varied by VA catchment area with values ranging from 27 % to 86 %. These differences persisted after further adjusting for mean HbA1c level, medication use and adherence as well as utilization and access metrics.
The wide variability in DR screening across 125 VA catchment areas indicates the presence of unmeasured determinants of DR screening. These results are relevant to clinical decision making in DR screening resource allocation.
•What is the influence of space on diabetic retinopathy screening adherence?•We adjusted for demographics, comorbidities, disease burden, and healthcare access metrics.•Screening adherence varied from 27 % to 86 % by catchment area.•Unexplained variation driven by geography or unmeasured determinants.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>37419770</pmid><doi>10.1016/j.pcd.2023.06.004</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-7197-2518</orcidid><orcidid>https://orcid.org/0000-0002-8929-6033</orcidid></addata></record> |
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| subjects | Adult Diabetes Mellitus Diabetic Retinopathy - diagnosis Diabetic Retinopathy - epidemiology Diabetic retinopathy screening Geographic determinants of health Glycated Hemoglobin Health Facilities Humans Mass Screening - methods United States - epidemiology Veterans Veterans Health |
| title | Geographic variation in diabetic retinopathy screening within the Veterans Health Administration |
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