Factors affecting global adherence for the uptake of diabetic retinopathy screening: A systematic review and meta-analysis

Purpose: To evaluate diabetic retinopathy (DR) screening global adherence rate and the association between sociodemographic and clinical variables and adherence rates to DR screening in individuals with diabetes.

Design: Systematic Review and Meta-Analysis

Methods: This systematic review was registered with International Prospective Register of Systematic Reviews (ID: CRD42024507035). We conducted a systematic review of relevant literature from inception of databases to February 24, 2024 using electronic databases searches including PubMed, MEDLINE (Ovid), EMBASE, Web of Science, Cochrane CENTRAL, and CDSR and national level DR screening databases through Google searches following PRISMA guidelines. The articles were screened for title and abstract and then for the full-text reports by two independent reviewers and study quality was appraised. Meta‐analysis was performed using random effects model to calculate the pooled effects size and 95% confidence interval (CI) of each finding.

Results: Data from a total of 11,383,715 participants from 77 studies and two national websites from 28 countries over five continents were included. Global DR screening adherence rate was 66.9% in high-income countries and 39.3% in low-and-middle-income countries. DR screening adherence rate was lowest in Africa (36.1%) and was highest in Europe (81.3%). Older age (odds ratio [OR] 1.45, 95% CI 1.30-1.62), higher education level (OR1.65, 95% CI 1.45-1.78), marriage (OR 1.42, 95% CI 1.14-1.77), living in an urban area (OR 1.57, 95% CI 1.08-2.29), higher family income (OR 1.29, 95% CI 1.24-1.35), having any health insurance (OR 1.90, 95% CI 1.56-2.31), longer duration of diabetes (OR 1.57, 95% CI 1.27-1.94), type 2 diabetes (OR 1.68, 95% CI 1.34-2.10), family history of diabetes (OR 2.25, 95% CI 1.56-3.25), vision impairment (OR 2.07, 95% CI 1.43-2.98), history of eye diseases (OR 1.99, 95% CI 1.36-2.90), insulin treatment (OR 1.38, 95% CI 1.37-1.39), and good mental health (OR 1.14, 95% CI 1.04-1.24) were associated with DR screening adherence.

Conclusion: This meta-analysis provides key information about which population subgroups may require more targeted intervention and highlights the urgent need to identify ways to improve adherence to DR screening.