PURPOSE To identify the characteristics that are associated with adherence to annual diabetic eye exams and patient awareness of retinopathy using a nationally representative sample from the United States. DESIGN Cross-sectional, secondary analysis. PARTICIPANTS National Health and Nutrition Examination Survey (NHANES) participants from 2005 to 2016 aged 20 years and older with diabetes mellitus. METHODS The NHANES collected surveys every 2 years from 2005 to 2016, which contained demographic information, clinical information, and time to last dilated eye exam. From 2005 to 2008, retinal photographs were taken of all participants older than 40 years of age. We used univariate and multivariable logistic regression to determine the demographic and clinical factors associated with adherence to annual diabetic eye examinations and those associated with correctly reporting their retinopathy status. MAIN OUTCOME MEASURE Factors associated with adherence defined as having an eye exam within the preceding 12 or 24 months. RESULTS From 2005 to 2016, NHANES surveyed 4072 individuals who represent 20 million Americans aged 20 years and older with self-report of diabetes. By using the adherence definitions of 12 and 24 months, 63.4% and 78.7%, respectively, were adherent to diabetic eye examinations. The nonadherence rates of 36.6% and 21.3% for this national estimate did not change from 2005 to 2016 (P = 0.7, logistic regression). Insurance status, age, education, income, cholesterol levels, duration of diabetes, and self-reported retinopathy were all significantly associated with adherence with both definitions (all P < 0.05, logistic regression). Insurance status had the highest predictive value, with 76% of Americans on combination private-public insurance adherent compared with 36% of uninsured. Most Americans with retinopathy incorrectly denied having the diagnosis (2 727 144/3 896 093 or 70%). CONCLUSIONS Multiple variables were associated with nonadherence to eye exams, with insurance status having the strongest association. Adherence with annual eye exams has not improved over the past decade. The majority of patients with retinopathy are unaware of this diagnosis, including the majority of those with a dilated funduscopic examination in the past year. Further improvements in education and adherence may reduce the visual morbidity caused by diabetes.

中文翻译：

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在美国确诊为糖尿病的患者中，与坚持每年进行的散瞳检查有关的特征。

目的使用来自美国的具有全国代表性的样本来鉴定与坚持每年进行的糖尿病眼检查和患者对视网膜病变的认识有关的特征。设计横断面，二级分析。参与者2005年至2016年的国家健康和营养检查调查（NHANES）参与者，年龄20岁及以上，患有糖尿病。方法NHANES从2005年至2016年每2年收集一次调查，其中包括人口统计学信息，临床信息以及上次散瞳检查的时间。从2005年到2008年，为所有40岁以上的参与者拍摄了视网膜照片。我们使用单变量和多变量logistic回归来确定与坚持每年进行糖尿病眼检查有关的人口统计学和临床​​因素，以及与正确报告其视网膜病变状态有关的人口统计学和临床​​因素。主要观察指标与依从性相关的因素定义为在过去12或24个月内进行眼科检查。结果从2005年到2016年，NHANES对4072个人进行了调查，这些人代表2000万年龄在20岁以上的美国糖尿病患者。通过使用12个月和24个月的依从性定义，分别有63.4％和78.7％的患者遵守了糖尿病眼科检查。从2005年到2016年，该国家/地区的不遵守率分别为36.6％和21.3％（P = 0.7，logistic回归）。保险状况，年龄，教育程度，收入，胆固醇水平，两种定义对糖尿病持续时间和自我报告的视网膜病变均与依从性显着相关（所有P <0.05，逻辑回归）。保险地位具有最高的预测价值，有76％的美国人采用私人-公共和公共保险相结合，而没有保险的人为36％。大多数患有视网膜病的美国人错误地否认了诊断（2 727 144/3 896 093或70％）。结论多个变量与不遵守眼科检查有关，而保险地位之间的联系最为密切。在过去的十年中，年度视力检查的依从性并未得到改善。大多数视网膜病患者不知道这种诊断，包括在过去一年中大多数进行了扩大眼底镜检查的患者。