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The effect of geodemographic factors on the attendance rates at a regional diabetic retinopathy treatment centre



To determine whether geodemographic factors, specifically age, gender or commuting distance, affect the attendance rates of patients referred to a Diabetic Retinopathy Treatment (DRT) Centre from the Irish National Diabetic Retinal Screening (DRS) Programme.


A retrospective analysis of the first 1200 patients who were referred for ophthalmic assessment between November 2013 and June 2015 to Cork University Hospital’s (CUH) DRT clinic from the DRS was completed.


A total of 972 (81%) patients attended all their scheduled DRT appointments. The attendance rates for those living in counties Cork and Kerry were 83.9% and 72.5%, respectively. Fifty-seven (4.75%) patients failed to attend any of their clinic appointments (2.2% of Cork and 11.8% of Kerry referrals). Patients living within 60 km of the treatment centre were more likely to attend (p = 0.013). Both age and gender were also shown to have a statistically significant impact on attendance, with those under 40 years of age (p < 0.001) and male patients (p = 0.02) less likely to attend their scheduled appointments.


This study suggests a correlation between geodemographic factors (age, gender and commuting distance) and attendance at a DRT Centre. The longer commuting distance for Kerry patients contributes to their higher non-attendance rates indicating a need to provide a Kerry-based satellite treatment centre to improve accessibility.

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  1. Mortality and Causes of Death Collaborators (2015) Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet 385(2013):117–171 GBD

    Google Scholar 

  2. Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2197–2223

    Article  Google Scholar 

  3. Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes; estimates for the year 2000 and projections for 2030. Diabetes Care 27(5):1047–1053

    Article  Google Scholar 

  4. Irish Department of Health and Children. Framework for the development of a diabetic retinopathy screening programme for Ireland c. November 2008. Available from: Accessed 15 April 2019

  5. Rhatigan MC, Leese GP, Ellis J, Ellingford A, Morris AD, Newton RW, Roxburgh ST (1999) Blindness in patients with diabetes who have been screened for eye disease. Eye 13:166–169

    Article  Google Scholar 

  6. Cormack TG, Grant B, Macdonald MJ, Steel J, Campbell IW (2001) Incidence of blindness due to diabetic eye disease in Fife 1990-9. Br J Ophthalmol 85:354–356

    CAS  Article  Google Scholar 

  7. NHS Centre for Reviews and Dissemination, University of York (1999) Complications of diabetes: screening for retinopathy, management of foot ulcers. Effective Health Care 5(4):1–12

    Google Scholar 

  8. Kelliher C, Kenny D, O’Brien C (2006) Trends in blind registration in the adult population of the Republic of Ireland 1996-2003. Br J Ophthalmol 90:367–371

    CAS  Article  Google Scholar 

  9. Tracey ML, McHugh SM, Fitzgerald AP, Buckley CM, Canavan RJ, Kearney PM (2016) Trends in blindness due to diabetic retinopathy among adults aged 18-69 years over a decade in Ireland. Diabetes Res Clin Pract 121:1–8

    CAS  Article  Google Scholar 

  10. Jönsson B (2002) Revealing the cost of type II diabetes in Europe. Diabetologia 45(7):5–12

    Article  Google Scholar 

  11. Association AD (2013) Economic costs of diabetes in the U.S. in 2012. Diabetes Care 36(4):1033–1046

    Article  Google Scholar 

  12. National Council for the Blind of Ireland (2011) The cost of sight loss: the economic impact of vision impairment and blindness in the Republic of Ireland. NCBI Publications, Dublin

    Google Scholar 

  13. Wilson JMG, Jungner G. Principles and practice of screening for disease. Public health paper number 34. Geneva: WHO, 1968

  14. National Institute for Health and Clinical Excellence. (2008) Type 2 diabetes; management of type 2 diabetes. Clinical guidelines CG66. London; NICE

  15. American Diabetes Association (2002) Diabetic retinopathy. Diabetes Care 25(suppl 1):s90–s93

    Google Scholar 

  16. Bachmann MO, Nelson S. (1996) Screening for diabetic retinopathy: a quantitative overview of the evidence, applied to the populations of health authorities and boards. Health Care Evaluation Unit, Department of Social Medicine: University of Bristol

  17. Javitt JC, Atello LP (1996) Cost effectiveness of determining and treating diabetic retinopathy. Ann Intern Med 124:164–169

    CAS  Article  Google Scholar 

  18. World Health Organisation (Europe), International Diabetes Foundation (Europe) (1990) Diabetes care and research in Europe: the St. Vincent declaration. Diabet Med 7(4):360

    Article  Google Scholar 

  19. Gray RH, Blades C, Jobson T (2009) Screening clinic non-attendance and the risk of sight threatening retinopathy. 19th meeting of the European Association for the study of diabetes eye complications study group (EASDec), Oxford, pp 22–24

    Google Scholar 

  20. Zoega GM, Gunnarsdottir T, Bjornsdottir S et al (2005) Screening compliance and visual outcome in diabetes. Acta Ophthalmol Scand 83(6):687–690

    Article  Google Scholar 

  21. Waqar S, Bullen G, Chant S, Salman R, Vaidya B, Ling R (2012) Cost implications, deprivation and geodemographic segmentation analysis of non-attenders (DNA) in an established diabetic retinopathy screening programme. Diabetes Metab Syndr Clin Res Rev 6:199–202

    Article  Google Scholar 

  22. GP Leese A, Emslie-Smith PB, Ellis JD, Feng Z (2008) Screening uptake in a well established diabetic retinopathy screening program. Diabetes Care 31(11):2131–2135

    Article  Google Scholar 

  23. Millett C, Dodhia H (2006) Diabetes retinopathy screening: audit of equity in participation and selected outcomes in South East London. Med Screen 13:152–155

    Article  Google Scholar 

  24. Irish Department of Health and Children. CervicalCheck Programme Report 2014/2015. Available at: Accessed 15 April 2019

  25. Scanlon PH, Stratton IM, Leese GP, Bachmann MO, Land M, Jones C, Ferguson B, the Four Nations Diabetic Retinopathy Screening Study Group (2016) Four nations diabetic retinopathy screening study group. Screening attendance, age group and diabetic retinopathy level at first screen. Diabet Med 33(7):904–911

    CAS  Article  Google Scholar 

  26. Dervan E, Lillis D, Flynn L, Staines A, O’Shea D (2008) The factors that influence the patient uptake of diabetic retinopathy screening. Ir J Med Sci 177:303–308

    CAS  Article  Google Scholar 

  27. Keenum Z, McGwin G Jr, Witherspoon CD, Haller JA, Clark ME, Owsley C (2016) Patients’ adherence to recommended follow-up eye care after diabetic retinopathy screening in a publicly funded county clinic and factors associated with follow-up eye care use. JAMA Ophthalmol 134(11):1221–1228

    Article  Google Scholar 

  28. Maxwell AJ (2000) Relocation of a static breast screening unit: a study of factors affecting attendance. J Med Screen 7(2):114–115

    CAS  Article  Google Scholar 

  29. Bennett GH, Tuthill A (2017) Investigating the barriers to the uptake of Diabetic RetinaScreen. Ir Med J 110(9):814–821

    Google Scholar 

  30. Robotham D, Satkunanathan S, Reynolds J, Stahl D, Wykes T (2016) Using digital notifications to improve attendance in clinic: systematic review and meta-analysis. BMJ Open 6(10):e012116

    Article  Google Scholar 

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Correspondence to Emily Greenan.

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Greenan, E., Salim, M., Coakley, D.N. et al. The effect of geodemographic factors on the attendance rates at a regional diabetic retinopathy treatment centre. Ir J Med Sci 188, 1207–1212 (2019).

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  • Diabetic retinopathy
  • Non-attendance
  • Patient compliance
  • Screening