A Diabetic Retinopathy Screening Tool for Low-Income Adults in Mexico

Details

• Journal Article:
  Preventing Chronic Disease (PCD)
• Personal Author:
  Mendoza-Herrera, Kenny ; Quezada, Amado D. ; Pedroza-Tobías, Andrea ; Hernández-Alcaraz, Cesar ; Fromow-Guerra, Jans ; Barquera, Simón
• Description:
  Introduction
  
  A national diabetic retinopathy screening program does not exist in Mexico as of 2017. Our objective was to develop a screening tool based on a predictive model for early detection of diabetic retinopathy in a low-income population.
  
  Methods
  
  We analyzed biochemical, clinical, anthropometric, and sociodemographic information from 1,000 adults with diabetes in low-income communities in Mexico (from 11,468 adults recruited in 2014–2016). A comprehensive ophthalmologic evaluation was performed. We developed the screening tool through the following stages: 1) development of a theoretical predictive model, 2) performance assessment and validation of the model using cross-validation and the area under the receiver operating characteristic curve (AUC ROC), and 3) optimization of cut points for the classification of diabetic retinopathy. We identified points along the AUC ROC that minimized the misclassification cost function and considered various scenarios of misclassification costs and diabetic retinopathy prevalence.
  
  Results
  
  Time since diabetes diagnosis, high blood glucose levels, systolic hypertension, and physical inactivity were considered risk factors in our screening tool. The mean AUC ROC of our model was 0.780 (validation data set). The optimized cut point that best represented our study population (z = −0.640) had a sensitivity of 82.9% and a specificity of 61.9%.
  
  Conclusion
  
  We developed a low-cost and easy-to-apply screening tool to detect people at high risk of diabetic retinopathy in Mexico. Although classification performance of our tool was acceptable (AUC ROC > 0.75), error rates (precision) depend on false-negative and false-positive rates. Therefore, confirmatory assessment of all cases is mandatory.
  
  
• Subjects:
  Aged Cost-Benefit Analysis Diabetes Mellitus, Type 2 Diabetic Retinopathy Female Humans Male Mass Screening Middle Aged Poverty Predictive Value Of Tests Risk Factors ROC Curve Time Factors

  More +
• Source:
  Prev Chronic Dis. 14.
• DOI:
  http://dx.doi.org/10.5888/pcd14.170157
• ISSN:
  1545-1151
• Pubmed ID:
  29023230
• Pubmed Central ID:
  PMC5645201
• Document Type:
  Journal Article
• Funding:
  R03 TW009061/TW/FIC NIH HHS/United States
• Place as Subject:
  Mexico
• Volume:
  14
• Collection(s):
  Preventing Chronic Disease
• Main Document Checksum:
  urn:sha-512:3639dae553caf5513e00275ae030d5a26f99cf847d08ecac94e5ed8b5ff79a3be8b55112397026ef6a28483a4cd33603d9eebd8071348275ffe2811c2b3217a5
• Download URL:
  https://stacks.cdc.gov/view/cdc/49464/cdc_49464_DS1.pdf
• File Type:
  [PDF - 446.94 KB ]