Socioeconomic Variables Responsible For Diabetic Retinopathy Among Bangladeshi Adults

The present study was to identify some responsible variables for the prevalence of diabetic retinopathy among adult people of Bangladesh. To fulfil the objective of the study, statistical analysis was done utilizing the data collected from 960 adults of both urban and rural areas of the country. The data were collected by some doctors and nurses from and nearby their working places. Among the investigated adults, 15.8 percent were suffering simultaneously from diabetes and retinopathy and majority (40.8%) of them were suffering for five to less than 10 years. More prevalence of the disease was observed among females, married persons, adults of ages 40 years and above, physically inactive group of persons, adults engaged in sedentary activities, higher income group of adults, obese group of people, adults of hypertension and among those who were taking can foods . The most responsible identified variables were age followed by family income and expenditure, marital status, utilization of time and duration of disease. These variables were identified by factor analysis. Abstract

questionnaire. The questionnaire contained questions related to different socioeconomic variables including the family income and expenditure of each of the adults. From diabetic patients, the information on duration of disease, complications facing due to the disease, level of blood pressure, etc, were also recorded. From all sample units, data on utilization of time, physical labor, food habit, etc. were also noted.
Some of the variables were qualitative in nature and some were quantitative in character. For analytical purpose, all the variables were transformed to nominal scores by assigning numbers. The association of diabetic retinopathy with different social and economic variables were investigated by Chi-square test. The association of DR with Body Mass Index (BMI) was also investigated. BMI was measured by weight (in kg) divided by height (in metre 2 ). The respondents were classified as underweight [ BMI < 20], normal [ 20 < BMI < 25], overweight [ 25 < BMI < 30]and obese [ BMI ≥ 30]. The significant association was decided when the p-value of any Chi-square test was less than or equal to 0.05.
To decide the risk of DR for adults the risk ratio was calculated along with its 95% confidence interval considering the prevalence of the disease for a level of any socioeconomic variable [27][28][29][30][31][32]. To identify the responsible variable for diabetic retinopathy, factor analysis was done for eigen value 2 so that maximum variation in the data set of diabetic retinopathy patients was explained. The analysis was done using SPSS version 25.

Result
The total investigated adults were 960. Out of them, the number of diabetic adults was 672 and 152 of them were suffering from diabetic retinopathy. The analytical results were prepared by classifying the adults in two groups, in one group there were 152 patients of DR and in another group, there were 808 adults including 288 normal subjects. Among the DR patients, 40.8 percent were suffering from the disease for 5 years to less than 10 years.
The percentages of patients suffering for less than 5 years, 10 years to less than 15 years and 15 years and above were 18  15.9 percent of these married group were affected by the disease.
The percentage of currently unmarried adults suffering from the disease was 9.3. Marital status was significantly associated with the prevalence of diabetic retinopathy [ 2 χ =13.267, p-value = 0.000]. The married adults were more than two times exposed to the dis- The investigated adults were classified into four groups according to their occupation. These groups were farmers and unskilled labors (26.6%), businesspersons and skilled workers (16.8%), service persons (22.2%) and housewives and students (34.5%). The first group rendered physical labor. The other three groups were not directly involved in physical labor. The grouping was done to observe the risk of DR for the adults who were physically inactive, because physical inactivity was identified as the responsible factor for diabetes [ 26,29]. The proportions of DR of the respondents were habituated in taking food from restaurant and 18.9 percent of them were suffering from DR. This group of adults were 61 percent more exposed to the disease compared to The obese adults were around 12 times more exposed to the respondents replied to a question regarding the utilization of time outside their normal duties. Some replied that they passed their   [30][31][32]. During the analysis one result known as communality give the initial idea about the importance of a variable to be retained in the analysis. In some cases, a value of communality 0.40 or less for a variable leads the researcher to drop that variable from the analysis. The results observed in doing the analysis of the present data were shown in Table 2  that age of adults and diabetic retinopathy was significantly associated and adults of ages 40 years and above were more than 4 times exposed to the disease. Similar findings were noted in both home and abroad [3,4,5,12]. The rural (43.5%) and urban adults Females were more affected by the disease. Similar finding was noted abroad [5]. The females were more than two times exposed and primary level educated adults together were 50 percent more exposed to the disease compared to that of secondary and higher educated adults. More illiterate adults (22.2%) were affected by the disease. Level of occupation was significantly associated with the prevalence of DR. Females and students were not directly involved in physical activity [29] and their relative risk of the disease was around two times compared to the risk of other adults. This group of respondents were higher in percentage compared to the percentage of other occupational groups. As in this group there were more females, the group was more exposed to the disease.

Factor Analysis
This phenomenon was already stated in studying the association of sex and prevalence of diabetic retinopathy. It was already mentioned that females were at higher risk of diabetic retinopathy . But significant, association of income and prevalence of DR was observed from the analysis. The significance was noted due to the findings were reported in abroad [5,12,13]. The adults having blood pressure 85 mmHg and above were more than 7 higher (28.6%) proportion of DR patients in the families of higher income.
These adults of DR patients in the highest income group of families were at risk more than two times compared to the risk of adults belonging to the families of other income levels. The adults (17.1%) belonging to the families spending highest amount of money (Taka 90 thousand and above) were suffering more in proportion. For this group of adults, the risk of the disease was 56 percent more than the risk for the adults of families spending money less that taka 90 thousand per month. However, monthly expenditure pattern and prevalence of DR were not significantly associated.
Body mass index was significantly associated with the prevalence of diabetic retinopathy. This phenomenon was observed in both home and abroad [6,13,14]. This study indicated that the risk of the disease for the obese adults was more than 5 times compared to the risk of other adults. The sedentary activities of the adults were significantly associated with the prevalence of diabetic retinopathy. Those who passed their time by reading paper and watching television (16.1%) outside their normal routine work, they were more exposed to the disease. For such group of adults, the risk of the disease was more than two times than the risk other adults.
Another significant responsible factor for diabetic retinopathy was hypertension. Similar times exposed to the disease. For this group, the risk of the disease was more than 4 times than the risk

Conclusion
The information presented in the paper were the analytical results collected from adults of 18 years and above residing in both urban and rural areas of Bangladesh. The data were collected by some doctors and nurses utilizing the technique of quota sampling.
Seven hundred diabetic patients and 300 normal adults were the target units for data collection as in some previous study [25]  In the sample, 43.5 % were rural residents, 55.2% were males, 82.6% were Muslim adults, 69.8% were currently married adults, 54.2% were of the ages 40 years and above, illiterate and primary educated adults were 17.6%, housewives and other occupational groups were 34.5%, percentages of rich families in terms of income and expenditure were 11.7 and 17.1 respectively. Percentages of obese, physically inactive adults and adults having blood pressure 85 mmHg and above were 14.5, 63.4 and 14.9, respectively. The percentages of adults habituated in taking restaurant food and can food were 51.4 and 60.8 respectively; 8.8 percent adults were involved in sedentary activities. Among the diabetic retinopathy patients 18.4 % were suffering for less than 5 years, 40.8% were suffering for 5 years and above but less than 10 years, 21.1% were suffering for 10 years and above but less than 15 years and the remaining 19.7% were suffering for 15 years and above. The analysis showed that the risk of diabetic retinopathy was higher for females, married adults, adults of ages 40 years and above, illiterate and primary educated adults, housewives and other occupational group of adults, adults of rich families in terms of income and expenditure, adults involved in sedentary activities, physically inactive adults, adults habituated in taking restaurant and can food and adults those who were in hypertension.
The analysis of association of DR with some socioeconomic and biological variables were done. Irrespective of significant or insignificant association, the degree of the risk of the disease due to some socioeconomic variables was evaluated. But this measurement of the risk ratio or odds ratio did not indicate the most responsible variable for the disease. The responsible variable was identified by factor analysis. The most responsible variable for the disease was age followed by utilization of time by the adults and the duration of the disease. The other responsible variables for the disease were family income and family expenditure followed by physical inactivity. From the analytical results it could be said that some of the social factors would be responsible for obesity, diabetes and diabetic related diseases. So, it cannot be avoided but there should be some attempts to reduce the intensity of obesity, diabetes and hence diabetic related diseases. For this, people should be motivated to avoid the sedentary activities so that they themselves can manage better and healthy life throughout their life span.
The following aspects can be considered, and attempts should be made to follow some norms which are essentials for better health management.
a. There should be some campaign to explain the need of avoiding the prevalence of non-communicable diseases by the health management authority and people should be advised to join the campaign in which the health hazard can be detected and accordingly they should be advised to consult the health workers for the treatment, b.
People should be advised to take such foods which do not create the problem of obesity and obesity-oriented diseases,