An Analysis Of Vision Loss Burden And Risk Factors Associated With Diabetic Retinopathy

Part 1 Global burden and socioeconomic disparity of vision loss due to diabetic retinopathyBackground and Purpose: Diabetic retinopathy(DR)is a common microvascular complication of diabetes,which becomes one of the main causes of visual impairment worldwide.With the improvement of living standards and aging of the population,the prevalence of DR has increased in recent years,posing a heavy burden on individuals and society.Therefore,this study aims to assess the distribution and trend patterns of global burden of vision loss due to DR in terms of year,age,gender and region,and to analyze the influence of socioeconomic development.Methods: Global prevalence,years lived with disability(YLDs)and age-standardized rate of DR from 1990 to 2017 were extracted from the Global Burden of Disease(GBD)Study 2017.Furthermore,the regional,national,and World Bank categorical DR-related vision loss burden were included.Besides,we included the Human development index(HDI)data.Pearson linear regression and Kruskal-Wallis test were used to analyze the relationship between age-standardized YLDs rate and HDI.Gini coefficient and concentration index were calculated to demonstrate the trends in between-country inequality in the DR-related vision loss burden.Results: Globally,all-age prevalence and YLDs number of vision loss due to DR increased steadily from 1990 to 2017,while the age-standardized prevalence and YLDs rates peaked around 2005 and then decreased.Females were more likely to suffer from vision loss due to DR than males.Global prevalence and YLDs rates increased with age.DR-related vision loss burden mainly existed in the Eastern Mediterranean countries.Among the fifteen major causes of vision loss,the age-standardized prevalence rate and YLDs rates of DR rose from 10 th in 1990 to 9th and 8th in 2017,respectively.The growth rate ranked second and first.The World Bank categorical vision loss burden associated with DR increased from 1990 to 2017,and rose with ageing.There was a significant difference in the age-standardized YLDs rate of DR among countries with different HDI levels(p<0.001): higher age-standardized YLDs rates mainly existed in middle-HDI and high-HDI countries.Gini coefficient decreased from 0.572 in 1990 to 0.542 in 2017.The concentration index was positive value,decreasing from 0.153 in 2000 to 0.061 in 2017.Conclusion: The vision loss burden due to DR,based on our projection,tended to increase under ageing population with a notable burden in females and the elderly.Countries with medium level of socioeconomic development owned higher vision loss burden of DR.Since 2000,the between-country inequality in DR burden witnessed a downward trend.Part 2 Burden of vision loss due to diabetic retinopathy in ChinaBackground and Purpose: As the largest developing country with rapid socioeconomic development,China has the largest number of patients with diabetes worldwide.This study aims to conduct a detailed analysis on the burden of vision loss due to DR by year,age,gender and vision loss classification in China to compare with other countries and other common causes of vision loss.Methods: The prevalence and YLDs data caused by DR in China,neighboring countries,and Group of Twenty(G20)countries were extracted from the GBD study 2017.Furthermore,the burden caused by the top 15 causes of vision loss in China was included.Results: All-age prevalence and YLDs number of DR in China increased significantly from 1990 to 2017.The age-standardized prevalence and YLDs rate witnessed a slowly declining trend recently.Higher prevalence and YLDs were observed in female subjects in the past three decades.Middle-aged and elderly people suffered from a higher burden of DR-induced vision loss.The age-standardized prevalence rate of China in 1990 and 2017 was lower than that of other seven neighboring countries,mostly moderate vision loss.China ranked 3rd among G20 countries in terms of all-age YLDs while ranked 18 th in age-standardized YLDs rate in 2017.The all-age YLDs of DR showed the second-significant increase(150.26%)while the age-standardized YLDs rate showed the third-significant increase(14.91%)among fifteen common causes of vision loss from 1990 to 2017.Conclusions: Over the past three decades,the prevalence and YLDs due to DR in China have improved in both genders.Although the age-standardized rates were lower than those in neighboring and G20 countries,the higher growth rate cannot be ignored.Part 3 Analysis of risk factors associated with type 2 diabetic retinopathyBackground and Purpose: The first two parts indicated that the vision loss burden due to DR showed an increasing trend both globally and in China.DR usually develops chronically and progressively.Further exploration of the contributing factors of DR in this process is helpful for a detailed understanding of DR.On the basis of the first two parts,this study aims to summarize the clinical characteristics and risk and protective factors of patients with DR by collecting clinical data from a specific hospital in the specific region.Methods: A total of 424 patients with type 2 diabetes from January 2020 to December 2020 were retrospectively included.These cases were divided into three groups: non-diabetic retinopathy(NDR),non-proliferative diabetic retinopathy(NPDR)and proliferative diabetic retinopathy(PDR).The basic clinical data,laboratory indicators,treatment,complications and comorbidities of patients were collected.Univariate analysis was used to analyze the clinical characteristics of patients.Multivariate Logistic regression analysis was performed on the significant variables in univariate analysis.Odds ratio(OR)and corresponding 95% confidence interval(CI)were calculated to study the risk factors and protective factors of DR in patients with type 2 diabetic retinopathy.Receiver operator characteristic curve(ROC)analysis was used to evaluate the predictive value of the factors.Results: The independent risk factors for the onset of NPDR included the course of diabetes(OR 1.014,95% CI: 1.010-1.018,p<0.001)and microalbuminuria(MAU)(OR 1.001,95% CI: 1.000-1.001,p=0.045).The independent risk factors for the onset of PDR included course of diabetes(OR 1.018,95% CI: 1.012-1.025,p<0.001)and MAU(OR 1.001,95% CI: 1.000-1.002,p<0.001).The middle(OR 0.321,95% CI: 0.121-0.853,p=0.023)and high education level(OR 0.069,95% CI: 0.006-0.748,p=0.028)were the protective factor for the onset of PDR(p<0.05).ROC curve analysis showed that the course of diabetes had a certain diagnostic predictive value for NPDR.Course of diabetes and MAU had a certain diagnostic predictive value for PDR.Conclusions: Course of diabetes and MAU were the independent risk factors for patients with PDR and NPDR.Middle and high education level were the protective factors for PDR.