Inadequate screening for retinopathy among recent immigrants with type 2 diabetes despite universal healthcare: a population-based study

Aims — To examine retinopathy screening and treatment rates for recent immigrants compared to non-immigrants in a universal healthcare system.

Methods — Linked healthcare and immigration databases were used to identify all 771,564 adults diagnosed with diabetes between 1996 and 2007, in Ontario, Canada. The cohort was stratified by their immigration status and followed until 2013 for retinopathy screening and treatment visits.

Results — Retinopathy screening rates were low, and recent immigrants were considerably less likely to receive screening than long-term residents (≥ 1 examination within 1 year: 37.5% vs. 50.5%, adjusted OR 0.76 [95% CI, 0.75–0.77]; ≥ 3 examinations within 6 years: 46.6% vs. 61.9%, adjusted OR 0.77 [95% Cl, 0.76–0.79]). Immigrants were also less likely to receive surgical treatment for retinopathy, but adjustment for the frequency of screening attenuated these differences.

Conclusions — Despite universal access to physician services, only half of all individuals with newly-diagnosed type 2 diabetes received retinopathy screening within the first year, and recent immigrants were markedly less likely to be screened. After adjusting for screening rates, gaps in surgical treatment for retinopathy were attenuated, suggesting that treatable retinopathy may be being missed among recent immigrants because of inadequate screening.