Use of Eye Care Services among Diabetic Patients in Urban and Rural China

Objective: To assess the use of eye care and its predictors among diabetic patients in China. Design: Cross-sectional, clinic-based study. Participants: Diabetic patients 18 years of age or older were recruited consecutively from an urban tertiary and community hospitals and from a rural clinic in Guangdong, China. Methods: Information obtained by questionnaire and chart review included: demographic and socioeconomic status, knowledge about diabetic retinopathy (DR), and ocular and medical history. Main Outcome Measures: Self-reported or chart history of an eye examination ever or within the preceding 12 months. Results: The participation rate among 889 eligible subjects was 92.7%. Among 824 participants (mean age, 62.6 +/- 12.9 years; 58.8% female), 550 (66.7%) had not been examined in the last year as recommended by the American Academy of Ophthalmology, and 356 (43.2%) had never been examined. For the rural hospital, these figures were 81.1% and 68.7%, respectively. In regression analyses, factors associated with having an eye examination in the last year were: attendance at urban hospitals (odds ratio [OR], 3.46 [P<0.001] and 1.76 [P = 0.021] for the tertiary and community hospitals, respectively, compared with the rural clinic), higher DR knowledge score (OR, 1.24; P = 0.001), greater concern about vision loss (OR, 1.22; P = 0.007), and recommendation of regular eye examinations by the provider (OR, 2.36; P = 0.011). Predictors of ever having an eye examination were similar. Monthly income and health insurance status were not predictive of being examined. Conclusions: These results suggest that the low proportion of diabetic receiving recommended annual eye examinations in China may be improved through patient and physician education.