Diabetes retinopathy screening: audit of equity in participation and selected outcomes in South East London

OBJECTIVES: To assess uptake of the diabetes retinopathy screening programme in South East London and examine variation in attendance and screening outcomes. METHODS: Cross-sectional study of patients on a centralized disease register invited for retinal screening during 2003. The influence of age, gender, deprivation, region of birth and type of diabetes on screening attendance and outcomes was assessed. RESULTS: An estimated 46% of residents with known diabetes (9750/21,104) were offered digital retinopathy screening during 2003. In all, 88.9% of patients who were invited for screening attended. Attendance rates were significantly lower in younger patients (< or = 40 years), in those with type 1 diabetes and in patients residing in areas with the highest levels of deprivation. A total of 28.9% of patients had background retinopathy or worse during 2003. Retinopathy was more common in older patients (>40 years) and in individuals with type 1 diabetes after adjusting for other factors. Patients born outside the United Kingdom and the Republic of Ireland were significantly more likely to present with retinopathy. CONCLUSIONS: This study identified considerable inequity in the delivery of a local diabetic retinopathy screening programme. Equity audits should form an integral component of ongoing quality assurance monitoring of retinopathy screening programmes.