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Sadat Mahmoudi Nezhad G, Razeghinejad R, Janghorbani M, Mohamadian A, Hassan Jalalpour M, Bazdar S, Salehi A, Molavi Vardanjani H. Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis. JOVR [Internet]. 2019Jul.18 [cited 2024Apr.19];14(3):321–335. Available from: https://knepublishing.com/index.php/JOVR/article/view/4790
https://doi.org/10.18502/jovr.v14i3.4790
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Golnoush Sadat Mahmoudi Nezhad
Golnoush Sadat Mahmoudi Nezhad
MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran; Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran; Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
-
Reza Razeghinejad
Reza Razeghinejad
Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
-
Mohsen Janghorbani
Mohsen Janghorbani
Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
-
Alireza Mohamadian
Alireza Mohamadian
Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
-
Mohammad Hassan Jalalpour
Mohammad Hassan Jalalpour
Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
-
Somaye Bazdar
Somaye Bazdar
MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran; Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran
-
Alireza Salehi
Alireza Salehi
MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran
-
Hossein Molavi Vardanjani
Hossein Molavi Vardanjani
MPH Department, Shiraz University of Medical Sciences, Shiraz, Iran
Published Date
- Jul 18, 2019
Prevalence, Incidence and Ecological Determinants of Diabetic Retinopathy in Iran: Systematic Review and Meta-analysis
Abstract
Purpose: To estimate the pooled prevalence and incidence of diabetic retinopathy (DR) in Iran and to investigate their correlations with the Human Development Index (HDI), healthcare access (i.e., density of specialists and sub-specialists), and methodological issues.
Methods: Electronic databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and local databases were searched for cohort and cross-sectional studies published prior to January 2018. Prevalence and incidence rates of DR were extracted from January 2000 to December 2017 and random effects models were used to estimate pooled effect sizes. The Joanna Briggs Institute critical appraisal tool was applied for quality assessment of eligible studies.
Results: A total of 55,445 participants across 33 studies were included. The pooled prevalence (95% CI) of DR in diabetic clinics (22 studies), eye clinics (4 studies), and general population (7 studies) was 31.8% (24.5 to 39.2), 57.8% (50.2 to 65.3), and 29.6% (22.6 to 36.5), respectively. It was 7.4% (3.9 to 10.8) for proliferative DR and 7.1% (4.9 to 9.4) for clinically significant macular edema. The heterogeneity of individual estimates of prevalence was highly significant. HDI (P < 0.001), density of specialists (P = 0.004), subspecialists (P < 0.001), and sampling site (P = 0.041) were associated with heterogeneity after the adjustment for type of DR, duration of diabetes, study year, and proportion of diabetics with controlled HbA1C.
Conclusion: Human development and healthcare access were correlated with the prevalence of DR. Data were scarce on the prevalence of DR in less developed provinces. Participant recruitment in eye clinics might overestimate the prevalence of DR.
Keywords:
Access to Health Care; Diabetic Retinopathy; Epidemiology; Human Development; Iran
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3. Tan GS, Gan A, Sabanayagam C, Tham YC, Neelam K, Mitchell P, et al. Ethnic differences in the prevalence
and risk factors of diabetic retinopathy: the Singapore epidemiology of eye diseases study. Ophthalmology
2018;125:529-536.
4. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet 2010. 10;376:124-136.
5. Flaxman SR, Bourne RR, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, et al. Global causes of blindness
and distance vision impairment 1990-2020: a systematic review and meta-analysis. The Lancet Glob Health
2017;5:e1221-e1234.
6. Solomon SD, Chew E, Duh EJ, Sobrin L, Sun JK, VanderBeek BL, et al. Diabetic retinopathy: a position statement
by the American Diabetes Association. Diabetes Care 2017;40:412-418.
7. Ding J, Wong TY. Current epidemiology of diabetic retinopathy and diabetic macular edema. Curr Diab Rep
2012;12:346-354.
8. Ting DSW, Cheung GCM, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol 2016;44:260-277.
9. Caglar C, Demir E, Kucukler FK, Durmus M. A bibliometric analysis of academic publication on diabetic retinopathy disease trends during 1980-2014: a global and medical view. Int J Ophthalmol 2016;9:1663.
10. Publications UN, Programme UND. Human Development Report 2016: Human Development for Everyone: United Nations Publications; 2017.
11. Esteghamati A, Larijani B, Aghajani MH, Ghaemi F, Kermanchi J, Shahrami A, et al. Diabetes in Iran: prospective analysis from first nationwide diabetes report of National Program for Prevention and Control of Diabetes (NPPCD2016). Sci Rep 2017;7:13461.
12. Safaeipour M, Maveddat E. Assessment of areas with an emphasis on social indicators-economic and human
development indicators in combination with the use of GIS techniques and TOPSIS. Studies on Urban Planning
2013;1:11-27 [In Persian].
13. Hatef E, Fotouhi A, Hashemi H, Mohammad K, Jalali KH. Prevalence of retinal diseases and their pattern in Tehran: the Tehran eye study. Retina 2008;28:755-762.
14. Amini M, Aminorroaya A, Safaei H, Behrooz Z, Teimori A. Prevalence of diabetic retinopathy in newly diagnosed type 2 diabetic patients in Isfahan, Iran. Acta Endocrinologica 2008;4:415-423.
15. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational
studies in epidemiology: a proposal for reporting. JAMA 2000;283:2008-2012.
16. Salz DA, Witkin AJ. Imaging in diabetic retinopathy. Middle East Afr J Ophthalmol 2015;22:145.
17. Joanna Briggs Institute. Critical appraisal tools. Australia: The University of Adelaide; 2018 [cited 2018 Jun 01].
Available from: http://joannabriggs.org/research/criticalappraisal-tools.html
18. Haghdoost A, Hashemi H, Haji Aghajani M, Janbabaee G, Maher A, Noori Hekmat S, et al. Specialized and
geographic distribution of specialists in Iran in 2016 and its estimates in 2026. Iran J Epidemiol 2018;13:122-132.
19. Brown LD, Cai TT, DasGupta A. Interval estimation for a binomial proportion. Stat Sci 2001;16:101-133.
20. Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q
statistic or I index? Psychol Methods 2006;11:193.
21. Janghorbani M, Amini M, Ghanbari H, Safaiee H. Incidence of and risk factors for diabetic retinopathy in Isfahan, Iran. Ophthalmic Epidemiol 2003;10:81-95.
22. Manaviat MR, Afkhami M, Shoja MR. Retinopathy and microalbuminuria in type II diabetic patients. BMC Ophthalmol 2004;4:9.
23. Abdollahi A, Daneshpazhooh M, Amirchaghmaghi E, Sheikhi S, Eshrati B, Bastanhagh M-H. Dermopathy and
retinopathy in diabetes: is there an association? Dermatology 2007;214:133-136.
24. Abdollahi A, Malekmadani M, Mansoori M, Bostak A, Mirshahi MAA. Prevalence of diabetic retinopathy in patients with newly diagnosed type II diabetes mellitus. Acta Med Iran 2006;44:415-419.
25. Amini M, Safaei H, Aminorroaya A. The incidence of microalbuminuria and its associated risk factors in type
2 diabetic patients in Isfahan, Iran. Rev Diabet Stud 2007;4:242.
26. Manaviat M, Rashidi M, Afkhami-Ardekani M. Four years incidence of diabetic retinopathy and effective factors on its progression in type II diabetes. Eur J Ophthalmol 2008;18:572-577.
27. Gharaagaji R, Fagihzadeh S, Meshkani M, Rohipor R. The prevalence of diabetic retinopathy and related risk factors in diabetic type I, in Tehran, Iran. Res J Bio Sci 2008;3:596- 600.
28. Golbahar J, Rahimi M, Tabei MB, Aminzadeh MA. Clinical risk factors and association of hyperhomocysteinemia with diabetic retinopathy in Iranian type 2 diabetes patients: a cross-sectional study from Shiraz, Southern Iran. Diabetes Metab Syndr 2008;2:192-201.
29. Hosseini SM, Maracy MR, Amini M, Baradaran HR. A risk score development for diabetic retinopathy screening in Isfahan-Iran. J Res Med Sci 2009;14:105.
30. Javadi MA, Katibeh M, Rafati N, Dehghan MH, Zayeri F, Yaseri M, et al. Prevalence of diabetic retinopathy in
Tehran province: a population-based study. BMC Ophthalmol 2009;9:12.
31. Soleymani A, Moazzezi Z, Gorjizadeh A. Frequency of Ophthalmic complications on 140 cases of Type II diabetes mellitus, Babol-Iran. World App Sci J 2012;18:550-553.
32. Javanbakht M, Abolhasani F, Mashayekhi A, Baradaran HR. Health related quality of life in patients with type 2
diabetes mellitus in Iran: a national survey. PLOS ONE 2012;7:e44526.
33. Najafi L, Malek M, Valojerdi AE, Aghili R, Khamseh ME, Fallah AE, et al. Dry eye and its correlation to diabetes
microvascular complications in people with type 2 diabetes mellitus. J Diabetes Complicat 2013;27:459-462.
34. Shaghaghi A, Ahmadi A, Matlabi H. Iranian patients require more pertinent care to prevent type 2 diabetes
complications. Adv Prev Med 2014;2014:409391.
35. Gholamhossein Y, Behrouz H, Asghar Z. Diabetic retinopathy risk factors: plasma erythropoietin as a risk factor for proliferative diabetic retinopathy. Korean J Ophthalmol 2014;28:373-378.
36. Hosseini MS, Rostami Z, Saadat A, Saadatmand SM, Naeimi E. Anemia and microvascular complications in
patients with type 2 diabetes mellitus. Nephrourol Mon 2014;6:e19976.
37. Maghbooli Z, Pasalar P, Keshtkar A, Farzadfar F, Larijani B. Predictive factors of diabetic complications: a possible link between family history of diabetes and diabetic retinopathy. J Diabetes Metab Disord 2014;13:55.
38. Tazhibi M, Sarrafzade S, Amini M. Retinopathy risk factors in type II diabetic patients using factor analysis and
discriminant analysis. J Educ Health Promot 2014;3:85.
39. Ghodsi R, HamayeliMeharbani H, Avand A-Q, Bordbar A, Ahmadzadeh S. A study on the prevalence of diabetic
complications in Fasa diabetes clinic. Asian J Med Pharm Res 2014;4:68-72.
40. Dehghan MH, Katibeh M, Ahmadieh H, Nourinia R, Yaseri M. Prevalence and risk factors for diabetic retinopathy in the 40 to 80 year-old population in Yazd, Iran: The Yazd Eye Study. J Diabetes 2015;7:139-141.
41. Azizi-Soleiman F, Heidari-Beni M, Ambler G, Omar R, Amini M, Hosseini S-M. Iranian risk model as a predictive tool for retinopathy in patients with type 2 diabetes. Can J Diabetes 2015;39:358-363.
42. Shamshirgaran SM, Ataei J, Alamdari MI, Safaeian A, Aminisani N. Predictors of health-related quality of life
among people with type II diabetes Mellitus in Ardabil, Northwest of Iran, 2014. Prim Care Diabetes 2016;10:244-
250.
43. Rasoulinejad SA, Hajian-Tilaki K, Mehdipour E. Associated factors of diabetic retinopathy in patients that referred to teaching hospitals in Babol. Caspian J Intern Med 2015;6:224.
44. Mehravar F, Mansournia MA, Holakouie-Naieni K, NasliEsfahani E, Mansournia N, Almasi-Hashiani A. Associations between diabetes self-management and microvascular complications in patients with type 2 diabetes. Epidemiol Health 2016;38:e2016004.
45. Valizadeh R, Moosazadeh M, Bahaadini K, Vali L, Lashkari T, Amiresmaili M. Determining the prevalence of retinopathy and its related factors among patients with type 2 Diabetes in Kerman, Iran. Osong Public Health Res
Perspect 2016;7:296-300.
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