Attendance in a national screening program for diabetic retinopathy: a population-based study of 205,970 patients

Anne Suhr Thykjær*, N. Andersen, T. Bek, S. Heegaard, J. Hajari, C. S. Laugesen, S. Möller, F. N. Pedersen, L. Rosengaard, K. C. Schielke, R. Kawasaki, K. Højlund, K. H Rubin, L. Stokholm, J. Grauslund

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

9 Citations (Scopus)
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Aims: A nationwide diabetic retinopathy (DR) screening program has been established in Denmark since 2013. We aimed to perform an evaluation of adherence to DR screenings and to examine whether non-adherence was correlated to DR progression. Methods: The population consisted of a register-based cohort, who participated in the screening program from 2013 to 2018. We analyzed age, gender, marital status, DR level (International Clinical DR severity scale, none, mild-, moderate-, severe non-proliferative DR (NPDR) and proliferative DR (PDR)), comorbidities and socioeconomic factors. The attendance pattern of patients was grouped as either timely (no delays > 33%), delayed (delays > 33%) or one-time attendance (unexplained). Results: We included 205,970 patients with 591,136 screenings. Rates of timely, delayed and one-time attendance were 53.0%, 35.5% and 11.5%, respectively. DR level at baseline was associated with delays (mild-, moderate-, severe NPDR and PDR) and one-time attendance (moderate-, severe NPDR and PDR) with relative risk ratios (RRR) of 1.68, 2.27, 3.14, 2.44 and 1.18, 2.07, 1.26, respectively (P < 0.05). Delays at previous screenings were associated with progression to severe NPDR or PDR (hazard ratio (HR) 2.27, 6.25 and 12.84 for 1, 2 and 3+ delays, respectively). Any given delay doubled the risk of progression (HR 2.28). Conclusions: In a national cohort of 205,970 patients, almost half of the patients attended DR screening later than scheduled or dropped out after first screening episode. This was, in particular, true for patients with any levels of DR at baseline. DR progression in patients with delayed attendance, increased with the number of missed appointments.

Original languageEnglish
JournalActa Diabetologica
Issue number11
Pages (from-to)1493-1503
Number of pages11
Publication statusPublished - Nov 2022

Bibliographical note

© 2022. The Author(s).


  • Attendance
  • Complications
  • Diabetes
  • Diabetic retinopathy
  • Progression
  • Screening


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