title: Inadequate screening for retinopathy among recent immigrants with type 2 diabetes despite universal health care: A population-based study.
abstract: OBJECTIVE
  To examine retinopathy screening and treatment rates for recent immigrants compared to non-immigrants in a universal health care system.
  
  
  METHODS
  Linked health care 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 1year: 37.5% vs. 50.5%, adjusted OR 0.76 [95% CI, 0.75-0.77]; ≥3 examinations within 6years: 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.
authors.affiliation: Division of Endocrinology and Metabolism, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Lovshin
authors.affiliation: Department of Medicine, University of Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: baiju.shah@ices.on.ca.
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000191:economics / Q000628:therapy; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000191:economics / Q000601:surgery / Q000628:therapy; D057286:Electronic Health Records; D054242:Emigrants and Immigrants; D018588:Fee-for-Service Plans; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D054525:Minority Health / Q000191:economics; D009864:Ontario; D012042:Registries; D013222:State Medicine / Q000191:economics; D013997:Time Factors
keywords: Health care access; Immigrants; Preventative care; Retinopathy; Screening