Elsevier

Ophthalmology

Volume 116, Issue 3, March 2009, Pages 461-467
Ophthalmology

Original article
Prevalence of Diabetic Retinopathy in Rural China: The Handan Eye Study

https://doi.org/10.1016/j.ophtha.2008.10.003Get rights and content

Purpose

To describe the age- and gender-specific prevalence, characteristics, and severity of diabetic retinopathy (DR) in a rural population in northern China.

Design

A population-based cross-sectional study.

Participants

A total of 6830 Han Chinese aged 30 years and older from 13 villages of Yongnian County, Handan City, Hebei Province, China.

Methods

All participants underwent a standardized interview, a comprehensive eye examination, and fasting blood glucose testing according to the American Diabetes Association diagnostic criteria (fasting plasma glucose ≥7.0 mmol/l). Retinal photographs obtained after pupil dilation were graded for the presence and severity of DR according to the modified Early Treatment Diabetic Retinopathy Study classification system.

Main Outcome Measures

Any DR, retinopathy grades, macular edema, or vision-threatening retinopathy.

Results

Of the 6830 eligible individuals participating in the study, 5597 (81.9%) had fasting blood glucose results available. Of these, 387 participants (6.9%) were diagnosed with diabetes mellitus, including 247 subjects with new diabetes mellitus (NDM) and 140 subjects with known diabetes mellitus (KDM). For these, gradable photographs were available for 368 subjects (95.1%). The overall prevalence of DR was 43.1% (95% confidence interval, 38.1–48.4) and was higher in persons with KDM (65.2%) than NDM (33.5%). The prevalence of proliferative DR, macular edema, and vision-threatening retinopathy was 1.6%, 5.2%, and 6.3%, respectively, with 12.1% with KDM having untreated vision-threatening DR. No age- or gender-related differences were present. The prevalence of DR was strongly related to duration of disease.

Conclusions

Our study reports a high prevalence of DR among adults 30 years and older with diabetes in rural China. On the basis of estimates obtained from our study, we projected that in rural China, 21.1 million persons aged 30+ years have diabetes and 9.2 million have DR, including 1.3 million with vision-threatening DR. There is a pressing need for appropriate screening and management of diabetes and its complications in rural China.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Study Design and Population

The Handan Eye Study is a population-based study designed to determine the prevalence of blindness, visual impairment, and common eye diseases in a rural population in northern China. Details of the study design, sampling plan, and baseline data are reported elsewhere.28 In brief, 7557 eligible people of Yongnian County, Handan, Hebei Province, aged 30 years and older, were identified from 13 randomly selected villages using a stratified, clustered, and multistaged sampling technique with

Results

Of the 6830 eligible participants, 5597 (81.9%) completed the FPG examination. Among the subjects with FPG results, 5460 (79.9%) had gradable fundus images. Those without glucose results or gradable photographs were older, were more often male, had less hypertension, and had lower systolic blood pressure, diastolic blood pressure, and body mass index (Table 1).

A total of 140 subjects reported that they had been diagnosed previously with DM (KDM), including 5 with no treatment, 7 treated with

Discussion

The current study provides data on the prevalence and characteristics of DR in a Chinese rural population aged 30 years or more in northern mainland China. The age-standardized prevalence of DR was 43.1%, the age-standardized prevalence of CSME was 3.5%, and the age-standardized prevalence of vision-threatening DR was 6.3% among participants with diabetes. More than 90% of those with vision-threatening retinopathy (requiring laser treatment) had not been treated. On the basis of estimates

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    Manuscript no. 2008-729.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the National Basic Research Program of China (973 Program) (No. 2007CB512201) from the Ministry of Science and Technology of the P.R. China, and the Program of Health Policy for blindness prevention from P.R. China. Partially founded by the Key Technologies R&D Program (No. 2006–10903) from the Bureau of Science and Technology of Handan City, P.R. China. With additional support from Beijing Tongren Hospital and key discipline fund of Bureau of Health, Handan City, P.R. China.

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