Global prevalence and major risk factors of diabetic retinopathy

Joanne W Y Yau, Sophie L Rogers, Ryo Kawasaki, Ecosse L Lamoureux, Jonathan W Kowalski, Toke Bek, Shih-Jen Chen, Jacqueline M Dekker, Astrid Fletcher, Jakob Grauslund, Steven Haffner, Richard F Hamman, M Kamran Ikram, Takamasa Kayama, Barbara E K Klein, Ronald Klein, Sannapaneni Krishnaiah, Korapat Mayurasakorn, Joseph P O'Hare, Trevor J Orchard, Massimo Porta, Mohan Rema, Monique S Roy, Tarun Sharma, Jonathan Shaw, Hugh Taylor, James M Tielsch, Rohit Varma, Jie Jin Wang, Ningli Wang, Sheila West, Liang Xu, Miho Yasuda, Xinzhi Zhang, Paul Mitchell, Tien Y Wong, Meta-Analysis for Eye Disease (META-EYE) Study Group, Joanne W Y Yau, Sophie L Rogers, Ryo Kawasaki, Ecosse L Lamoureux, Tien Y Wong, Jonathan W Kowalski, Suresh Mahabhashyam, Wei-Shi Yeh, Tin Aung, Seang Mei Saw, Wanting Tay, Wanling Wong, Francesco Panero, Massimo Porta, Graziella Bruno, Supak Caengow, Nawarat Somthip, Nahathai Chuikarat, Molee Wanichsuwan, Korapat Mayurasakorn, Shih-Jen Chen, Ching-Yu Cheng, Pesus Chou, Wen-Ming Hsu, Jorn-Hon Liu, Usha Chakravarthy, Mary Frances Cotch, Johannes Vingerling, Paulus De Jong, M Kamran Ikram, Hata Zavrelova, Giel Nijpels, Jacqueline M Dekker, Astrid Fletcher, Jakob Grauslund, Anne Katrin Sjølie, Toke Bek, Michael Stern, Steven Haffner, Richard F Hamman, Miho Yasuda, Tatsuro Ishibashi, Yutaka Kiyohara, Richard A Jensen, Jost B Jonas, Takeo Kato, Hidetoshi Yamashita, Takamasa Kayama, Beatriz Munoz, Joanna Katz, Sheila West, James M Tielsch, David Friedman, Ronald Klein, Barbara E K Klein, Sannapaneni Krishnaiah, Donna M Lehman, Catherine McCarty, Rachel G Miller, Trevor Orchard, Rajendra Pradeepa, Rema Mohan, Viswanathan Mohan, Joseph Paul O'Hare, Neil T Raymond, B C P Polak, Jie Jin Wang, Paul Mitchell, Elena Rochtchina, Monique S Roy, Rajiv Raman, Tarun Sharma, Mina Torres, Rohit Varma, Johan Seland, Jesus Vioque, Feng Hua Wang, Ning Li Wang, Yuan Bo Liang, Qi Sheng You, Liang Xu, Xing Yuan Zhang, Ya Xing Wang, Ian Young, Xinzhi Zhang, Hugh R Taylor, David S Siscovick, Coen D A Stehouwer, Mati Rahu, Gisele Soubrane, Laura Tomazzoli, Fotis Topouzis, Jonathan Shaw, Paul Zimmet, Joanne W Y Yau, Sophie L Rogers, Ryo Kawasaki, Ecosse L Lamoureux, Jonathan W Kowalski, Toke Bek, Shih-Jen Chen, Jacqueline M Dekker, Astrid Fletcher, Jakob Grauslund, Steven Haffner, Richard F Hamman, M Kamran Ikram, Takamasa Kayama, Barbara E K Klein, Ronald Klein, Sannapaneni Krishnaiah, Korapat Mayurasakorn, Joseph P O'Hare, Trevor J Orchard, Massimo Porta, Mohan Rema, Monique S Roy, Tarun Sharma, Jonathan Shaw, Hugh Taylor, James M Tielsch, Rohit Varma, Jie Jin Wang, Ningli Wang, Sheila West, Liang Xu, Miho Yasuda, Xinzhi Zhang, Paul Mitchell, Tien Y Wong, Meta-Analysis for Eye Disease (META-EYE) Study Group, Joanne W Y Yau, Sophie L Rogers, Ryo Kawasaki, Ecosse L Lamoureux, Tien Y Wong, Jonathan W Kowalski, Suresh Mahabhashyam, Wei-Shi Yeh, Tin Aung, Seang Mei Saw, Wanting Tay, Wanling Wong, Francesco Panero, Massimo Porta, Graziella Bruno, Supak Caengow, Nawarat Somthip, Nahathai Chuikarat, Molee Wanichsuwan, Korapat Mayurasakorn, Shih-Jen Chen, Ching-Yu Cheng, Pesus Chou, Wen-Ming Hsu, Jorn-Hon Liu, Usha Chakravarthy, Mary Frances Cotch, Johannes Vingerling, Paulus De Jong, M Kamran Ikram, Hata Zavrelova, Giel Nijpels, Jacqueline M Dekker, Astrid Fletcher, Jakob Grauslund, Anne Katrin Sjølie, Toke Bek, Michael Stern, Steven Haffner, Richard F Hamman, Miho Yasuda, Tatsuro Ishibashi, Yutaka Kiyohara, Richard A Jensen, Jost B Jonas, Takeo Kato, Hidetoshi Yamashita, Takamasa Kayama, Beatriz Munoz, Joanna Katz, Sheila West, James M Tielsch, David Friedman, Ronald Klein, Barbara E K Klein, Sannapaneni Krishnaiah, Donna M Lehman, Catherine McCarty, Rachel G Miller, Trevor Orchard, Rajendra Pradeepa, Rema Mohan, Viswanathan Mohan, Joseph Paul O'Hare, Neil T Raymond, B C P Polak, Jie Jin Wang, Paul Mitchell, Elena Rochtchina, Monique S Roy, Rajiv Raman, Tarun Sharma, Mina Torres, Rohit Varma, Johan Seland, Jesus Vioque, Feng Hua Wang, Ning Li Wang, Yuan Bo Liang, Qi Sheng You, Liang Xu, Xing Yuan Zhang, Ya Xing Wang, Ian Young, Xinzhi Zhang, Hugh R Taylor, David S Siscovick, Coen D A Stehouwer, Mati Rahu, Gisele Soubrane, Laura Tomazzoli, Fotis Topouzis, Jonathan Shaw, Paul Zimmet

Abstract

Objective: To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes.

Research design and methods: A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20-79 years.

Results: A total of 35 studies (1980-2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5-34.8) for any DR, 6.96% (6.87-7.04) for proliferative DR, 6.81% (6.74-6.89) for diabetic macular edema, and 10.2% (10.1-10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A(1c), and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes.

Conclusions: There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics.

References

    1. Klein BE. Overview of epidemiologic studies of diabetic retinopathy. Ophthalmic Epidemiol 2007;14:179–183
    1. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4–14
    1. Yang W, Lu J, Weng J, et al. ; China National Diabetes and Metabolic Disorders Study Group Prevalence of diabetes among men and women in China. N Engl J Med 2010;362:1090–1101
    1. Rema M, Premkumar S, Anitha B, Deepa R, Pradeepa R, Mohan V. Prevalence of diabetic retinopathy in urban India: the Chennai Urban Rural Epidemiology Study (CURES) eye study, I. Invest Ophthalmol Vis Sci 2005;46:2328–2333
    1. Wong TY, Klein R, Islam FM, et al. Diabetic retinopathy in a multi-ethnic cohort in the United States. Am J Ophthalmol 2006;141:446–455
    1. Kempen JH, O’Colmain BJ, Leske MC, et al. ; Eye Diseases Prevalence Research Group The prevalence of diabetic retinopathy among adults in the United States. Arch Ophthalmol 2004;122:552–563
    1. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 1984;102:527–532
    1. International Diabetes Federation. Diabetes Atlas Prevalence estimates of diabetes mellitus (DM) [Internet] 2010. Brussels, Belgium, International Diabetes Federation. Available at Accessed 31 December 2010
    1. Keyfitz N. 3. Sampling variance of standardized mortality rates. Hum Biol 1966;38:309–317
    1. Central Intelligence Agency. The World Factbook, Ethnic Groups by Country. [Internet] 2010. Washington, DC, Central Intelligence Agency. Available at Accessed 2 June 2011
    1. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984;102:520–526
    1. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. IV. Diabetic macular edema. Ophthalmology 1984;91:1464–1474
    1. Klein R, Klein BE, Moss SE, Linton KL. The Beaver Dam Eye Study. Retinopathy in adults with newly discovered and previously diagnosed diabetes mellitus. Ophthalmology 1992;99:58–62
    1. Mitchell P, Smith W, Wang JJ, Attebo K. Prevalence of diabetic retinopathy in an older community. The Blue Mountains Eye Study. Ophthalmology 1998;105:406–411
    1. West SK, Klein R, Rodriguez J, et al. ; Proyecto VER Diabetes and diabetic retinopathy in a Mexican-American population: Proyecto VER. Diabetes Care 2001;24:1204–1209
    1. Varma R, Torres M, Peña F, Klein R, Azen SP; Los Angeles Latino Eye Study Group Prevalence of diabetic retinopathy in adult Latinos: the Los Angeles Latino eye study. Ophthalmology 2004;111:1298–1306
    1. Tapp RJ, Shaw JE, Harper CA, et al. ; AusDiab Study Group The prevalence of and factors associated with diabetic retinopathy in the Australian population. Diabetes Care 2003;26:1731–1737
    1. Roy MS, Klein R, O’Colmain BJ, Klein BE, Moss SE, Kempen JH. The prevalence of diabetic retinopathy among adult type 1 diabetic persons in the United States. Arch Ophthalmol 2004;122:546–551
    1. Wong TY, Cheung N, Tay WT, et al. Prevalence and risk factors for diabetic retinopathy: the Singapore Malay Eye Study. Ophthalmology 2008;115:1869–1875
    1. Wang FH, Liang YB, Zhang F, et al. Prevalence of diabetic retinopathy in rural China: the Handan Eye Study. Ophthalmology 2009;116:461–467
    1. Wong TY, Mwamburi M, Klein R, et al. Rates of progression in diabetic retinopathy during different time periods: a systematic review and meta-analysis. Diabetes Care 2009;32:2307–2313
    1. Haffner SM, Fong D, Stern MP, et al. Diabetic retinopathy in Mexican Americans and non-Hispanic whites. Diabetes 1988;37:878–884
    1. Haffner SM, Mitchell BD, Moss SE, et al. Is there an ethnic difference in the effect of risk factors for diabetic retinopathy? Ann Epidemiol 1993;3:2–8
    1. Hamman RF, Mayer EJ, Moo-Young GA, Hildebrandt W, Marshall JA, Baxter J. Prevalence and risk factors of diabetic retinopathy in non-Hispanic whites and Hispanics with NIDDM. San Luis Valley Diabetes Study. Diabetes 1989;38:1231–1237
    1. Harris MI, Klein R, Cowie CC, Rowland M, Byrd-Holt DD. Is the risk of diabetic retinopathy greater in non-Hispanic blacks and Mexican Americans than in non-Hispanic whites with type 2 diabetes? A U.S. population study. Diabetes Care 1998;21:1230–1235
    1. Liew G, Klein R, Wong TY. The role of genetics in susceptibility to diabetic retinopathy. Int Ophthalmol Clin 2009;49:35–52
    1. Harris EL, Feldman S, Robinson CR, Sherman S, Georgopoulos A. Racial differences in the relationship between blood pressure and risk of retinopathy among individuals with NIDDM. Diabetes Care 1993;16:748–754
    1. Zhang X, Saaddine JB, Chou CF, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA 2010;304:649–656
    1. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy. JAMA 1988;260:2864–2871
    1. The Diabetes Control and Complications Trial Research Group The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–986
    1. McKay R, McCarty CA, Taylor HR. Diabetic retinopathy in Victoria, Australia: the Visual Impairment Project. Br J Ophthalmol 2000;84:865–870
    1. Patel A, MacMahon S, Chalmers J, et al. ; ADVANCE Collaborative Group Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560–2572
    1. Roy MS. Diabetic retinopathy in African Americans with type 1 diabetes: The New Jersey 725: II. Risk factors. Arch Ophthalmol 2000;118:105–115
    1. Keech AC, Mitchell P, Summanen PA, et al. ; FIELD study investigators Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial. Lancet 2007;370:1687–1697
    1. Collins R, Armitage J, Parish S, Sleigh P, Peto R; Heart Protection Study Collaborative Group MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet 2003;361:2005–2016
    1. Colhoun HM, Betteridge DJ, Durrington PN, et al. ; CARDS investigators Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004;364:685–696
    1. Roy MS. Diabetic retinopathy in African Americans with type 1 diabetes: The New Jersey 725: I. Methodology, population, frequency of retinopathy, and visual impairment. Arch Ophthalmol 2000;118:97–104

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться