Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 1;141(5):479-485.
doi: 10.1001/jamaophthalmol.2023.0809.

Epidemiology of Retinopathy of Prematurity in the US From 2003 to 2019

Anshul Bhatnagar  1 , Henry C Skrehot  1 , Amit Bhatt  2 , Honey Herce  2 , Christina Y Weng  3
Affiliations

Epidemiology of Retinopathy of Prematurity in the US From 2003 to 2019

Anshul Bhatnagar et al. JAMA Ophthalmol. .

Abstract

Importance: Retinopathy of prematurity (ROP) is a potentially blinding retinal disease with poorly defined epidemiology. Understanding of which infants are most at risk for developing ROP may foster targeted detection and prevention efforts.

Objective: To identify changes in ROP incidence in the US from 2003 to 2019.

Design, setting, and participants: This retrospective database cohort study used the Healthcare Cost and Utilization Project Kids' Inpatient Databases. These nationwide databases are produced every 3 years, include data from over 4000 hospitals, and are designed to generate national estimates of health care trends in the US. Participants included pediatric newborns at risk for ROP development between 2003 and 2019. Data were analyzed from September 30, 2021, to January 13, 2022.

Exposures: Premature or low-birth-weight infants with relevant International Classification of Diseases, Ninth Revision or Tenth Revision codes were considered ROP candidates. Infants with ROP were identified using relevant codes.

Main outcomes and measures: ROP incidence in selected subpopulations (based on database-reported race and ethnicity, sex, location, income) was measured. To determine whether incidences varied across time or subpopulations, χ2 tests of independence were used.

Results: This study included 125 212 ROP discharges (64 715 male infants [51.7%]) from 23 187 683 births. The proportion of premature infants diagnosed with ROP increased from 4.4% (11 720 of 265 650) in 2003 to 8.1% (27 160 of 336 117) in 2019. Premature infants from the lowest median household income quartile had the greatest proportional increase of ROP diagnoses from 4.9% (3244 of 66 871) to 9.0% (9386 of 104 235; P < .001). Premature Black infants experienced the largest increase from 5.8% (2124 of 36 476) to 11.6% (7430 of 63 925; P < .001) relative to other groups (2.71%; 95% CI, 2.56%-2.87%; P < .001). Hispanic infants experienced the second largest increase from 4.6% (1796 of 39 106) to 8.2% (4675 of 57 298; P < .001) relative to other groups (-0.16%; 95% CI, -0.29% to -0.03%; P = .02). The Southern US experienced the greatest proportional growth of ROP diagnoses, increasing from 3.7% (3930 of 106 772) to 8.3% (11 952 of 144 013; P < .001) relative to other groups (1.61%; 95% CI, 1.51%-1.71%; P < .001). ROP diagnoses proportionally increased in urban areas and decreased in rural areas.

Conclusions and relevance: This cohort study found that ROP incidence among premature infants increased from 2003 to 2019, especially among Black and Hispanic infants. Infants from the lowest-income areas persistently had the highest proportional incidence of ROP, and all regions experienced a significant increase in ROP incidence with the most drastic changes occurring in the South. These trends suggest that ROP is a growing problem in the US and may be disproportionately affecting historically marginalized groups.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Weng reported receiving consultant fees from Allergan/AbbVie, Alcon, Alimera Sciences, Dutch Ophthalmic Research Center, Genentech, REGENXBIO, Regeneron, Opthea, EyePoint, and Novartis and contracted research support from Diabetic Retinopathy Clinical Research Retina Network and AGTC outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Retinopathy of Prematurity (ROP) Incidence Between 2003 and 2019
ROP incidence increased from 4.4% in 2003 to 8.1% in 2019, an 86% change increase. Incidence increased most rapidly between 2006 and 2012.
Figure 2.
Figure 2.. Retinopathy of Prematurity (ROP) Incidence Across Races and Ethnicities Between 2003 and 2019
ROP incidence increased across all races and ethnicities between 2003 and 2019. ROP incidence was persistently highest among Black ROP candidates relative to other races and ethnicities, doubling from 5.8% in 2003 to 11.6% in 2019.
Figure 3.
Figure 3.. Retinopathy of Prematurity (ROP) Incidence Across Geographic Region Between 2003 and 2019
ROP incidence increased in all geographic regions between 2003 and 2019, with Southern urban areas experiencing the largest relative increase (123%).
Figure 4.
Figure 4.. Retinopathy of Prematurity (ROP) Incidence Across Median Household Income (MHI) Quartile Based on Zip Codes Between 2003 and 2019
ROP incidence increased in all MHI quartiles between 2003 and 2019, disproportionately affecting those born to parents residing in the lowest income quartile areas.
See this image and copyright information in PMC

Comment in

References

    1. Hartnett ME, Penn JS. Mechanisms and management of retinopathy of prematurity. N Engl J Med. 2012;367(26):2515-2526. doi:10.1056/NEJMra1208129 - DOI - PMC - PubMed
    1. Clark D, Mandal K. Treatment of retinopathy of prematurity. Early Hum Dev. 2008;84(2):95-99. doi:10.1016/j.earlhumdev.2007.11.007 - DOI - PubMed
    1. Gilbert C. Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control. Early Hum Dev. 2008;84(2):77-82. doi:10.1016/j.earlhumdev.2007.11.009 - DOI - PubMed
    1. Gilbert C, Malik ANJ, Nahar N, et al. . Epidemiology of ROP update—Africa is the new frontier. Semin Perinatol. 2019;43(6):317-322. doi:10.1053/j.semperi.2019.05.002 - DOI - PubMed
    1. Ludwig CA, Chen TA, Hernandez-Boussard T, Moshfeghi AA, Moshfeghi DM. The epidemiology of retinopathy of prematurity in the US. Ophthalmic Surg Lasers Imaging Retina. 2017;48(7):553-562. doi:10.3928/23258160-20170630-06 - DOI - PubMed