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Comment
. 2023 Aug 1;141(8):747-754.
doi: 10.1001/jamaophthalmol.2023.2289.

Prevalence of Diabetic Retinopathy in the US in 2021

Elizabeth A Lundeen  1 , Zeb Burke-Conte  2 , David B Rein  3 , John S Wittenborn  3 , Jinan Saaddine  1 , Aaron Y Lee  4 , Abraham D Flaxman  2
Affiliations
Comment

Prevalence of Diabetic Retinopathy in the US in 2021

Elizabeth A Lundeen et al. JAMA Ophthalmol. .

Abstract

Importance: Diabetic retinopathy (DR) is a common microvascular complication of diabetes and a leading cause of blindness among working-age adults in the US.

Objective: To update estimates of DR and vision-threatening diabetic retinopathy (VTDR) prevalence by demographic factors and US county and state.

Data sources: The study team included data from the National Health and Nutrition Examination Survey (2005 to 2008 and 2017 to March 2020), Medicare fee-for-service claims (2018), IBM MarketScan commercial insurance claims (2016), population-based studies of adult eye disease (2001 to 2016), 2 studies of diabetes in youth (2021 and 2023), and a previously published analysis of diabetes by county (2012). The study team used population estimates from the US Census Bureau.

Study selection: The study team included relevant data from the US Centers for Disease Control and Prevention's Vision and Eye Health Surveillance System.

Data extraction and synthesis: Using bayesian meta-regression methods, the study team estimated the prevalence of DR and VTDR stratified by age, a nondifferentiated sex and gender measure, race, ethnicity, and US county and state.

Main outcomes and measures: The study team defined individuals with diabetes as those who had a hemoglobin A1c level at 6.5% or more, took insulin, or reported ever having been told by a physician or health care professional that they have diabetes. The study team defined DR as any retinopathy in the presence of diabetes, including nonproliferative retinopathy (mild, moderate, or severe), proliferative retinopathy, or macular edema. The study team defined VTDR as having, in the presence of diabetes, severe nonproliferative retinopathy, proliferative retinopathy, panretinal photocoagulation scars, or macular edema.

Results: This study used data from nationally representative and local population-based studies that represent the populations in which they were conducted. For 2021, the study team estimated 9.60 million people (95% uncertainty interval [UI], 7.90-11.55) living with DR, corresponding to a prevalence rate of 26.43% (95% UI, 21.95-31.60) among people with diabetes. The study team estimated 1.84 million people (95% UI, 1.41-2.40) living with VTDR, corresponding to a prevalence rate of 5.06% (95% UI, 3.90-6.57) among people with diabetes. Prevalence of DR and VTDR varied by demographic characteristics and geography.

Conclusions and relevance: US prevalence of diabetes-related eye disease remains high. These updated estimates on the burden and geographic distribution of diabetes-related eye disease can be used to inform the allocation of public health resources and interventions to communities and populations at highest risk.

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Conflict of interest statement

Conflict of Interest Disclosures: Mr Burke-Conte reported grants from NORC at the University of Chicago during the conduct of the study. Dr Flaxman reported grants from NORC during the conduct of the study; fees from Janssen, SwissRe, Evaluation Merck for Mothers, and Sanofi for assistance in analysis and interpretation of licensed data previously produced by Institute for Health Metrics and Evaluation; and advising fees from Agathos outside the submitted work. Dr Rein reported grants from the US Centers for Disease Control and Prevention Vision Health Initiative during the conduct of the study and outside the submitted work. Dr Lee reports grants from Santen, iCareWorld, Topcon, Carl Zeiss Meditec, Meta, Amazon, and Regeneron; personal fees from Genentech, the US Food and Drug Administration, Boehringer Ingelheim, Johnson and Johnson, and Gyroscope; and nonfinancial support from Microsoft outside the submitted work. Dr Flaxman reported grants from NORC during the conduct of the study and assistance in analysis and interpretation of licensed data previously produced by the Institute for Health Metrics and Evaluation from Janssen, SwissRe, and Sanofi outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. US Prevalence of Diabetic Retinopathy Among People With Diabetes by Age, Race, and Ethnicity in 2021
Figure 2.
Figure 2.. Age–, Sex and Gender–, Race and Ethnicity–Standardized Diabetic Retinopathy Prevalence Among the Total Population by County in 2021
We used a nondifferentiated sex and gender indicator for standardization, which is a composite of sex- and gender–related variables in our data sources. No data sources measured sex and gender separately or included values besides “male” and “female.”
Figure 3.
Figure 3.. US Prevalence of Vision-Threatening Diabetic Retinopathy (DR) Among People With Diabetes by Age, Race, and Ethnicity in 2021
Figure 4.
Figure 4.. Age-, Sex and Gender–, and Race and Ethnicity–Standardized Vision-Threatening Diabetic Retinopathy Prevalence Among the Total Population by County in 2021
We used a nondifferentiated sex and gender indicator for standardization, which is a composite of sex- and gender–related variables in our data sources. No data sources measured sex and gender separately or included values besides “male” and “female.”
See this image and copyright information in PMC

Comment on

References

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