RT Journal Article
SR Electronic
T1 Diabetes-induced eye disease among First Nations people in Ontario: a longitudinal, population-based cohort study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E282
OP E288
DO 10.9778/cmajo.20200005
VO 8
IS 2
A1 Robert J. Campbell
A1 Roseanne Sutherland
A1 Shahriar Khan
A1 Katharine M. Doliszny
A1 Philip L. Hooper
A1 Morgan Slater
A1 Eliot Frymire
A1 Baiju R. Shah
A1 Jennifer D. Walker
A1 Michael E. Green
YR 2020
UL http://www.cmajopen.ca/content/8/2/E282.abstract
AB Background: In Canada, First Nations populations experience a higher incidence of diabetes and diabetes-related complications than other people. Given the paucity of information on use of preventive eye examinations and the need for interventional care for severe retinopathy among First Nations people, we carried out a population-based study to compare rates of eye examinations and interventional therapies to treat vision-threatening stages of diabetic retinopathy among First Nations people and other people with diabetes in Ontario.Methods: In collaboration with the Chiefs of Ontario, we carried out a population-based study to identify cohorts of First Nations people and other people with diabetes in Ontario from 1995/96 to 2014/15. We used linked health administrative databases to evaluate rates of eye examination (2005/06−2014/15) and severe diabetic retinopathy treatment and compared them between the 2 populations, and between First Nations people living in and outside of First Nations communities.Results: We identified 23 013 First Nations people and 1 364 222 other people diagnosed with diabetes from 1995/96 to 2014/15, of whom 49.8% (95% confidence interval [CI] 48.9%–50.7%) and 53.8% (95% CI 53.7%–54.0%), respectively, received an eye examination in 2014/15. Eye examination rates were similar for First Nations people regardless of whether they lived in or outside a First Nations community. First Nations people developed severe diabetic retinopathy at a faster rate than other people (hazard ratio 1.19, 95% CI 1.02–1.38). The gap between First Nations people and other people in the proportion requiring therapy for severe diabetic retinopathy was especially prominent among younger people. There were no significant differences in rates of diabetic retinopathy treatment in First Nations people stratified by place of residence.Interpretation: Eye examination rates remain suboptimal among people with diabetes in Ontario and were lower among First Nations people. This is particularly concerning in light of our other findings showing an increased risk of requiring treatment for advanced diabetic retinopathy and the accelerated rate of diabetic retinopathy progression among First Nations people with diabetes.See related article at www.cmajopen.ca/lookup/doi/10.9778/cmajo.20190096