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Multicenter Study
. 2024 Jul 1;142(7):599-606.
doi: 10.1001/jamaophthalmol.2024.0046.

Longitudinal Trends and Disparities in Diabetic Retinopathy Within an Aggregate Health Care Network

Jonathan Markle  1 , Jacqueline K Shaia  1   2 , Harman Araich  1 , Neha Sharma  1   2 , Katherine E Talcott  2   3   4 , Rishi P Singh  2   4   5
Affiliations
Multicenter Study

Longitudinal Trends and Disparities in Diabetic Retinopathy Within an Aggregate Health Care Network

Jonathan Markle et al. JAMA Ophthalmol. .

Abstract

Importance: Diabetic retinopathy (DR) is a leading cause of blindness in the US, warranting updates on its prevalence and incidence in the setting of advancements in diabetic care over recent years.

Objective: To determine recent trends in DR prevalence stratified by baseline demographics to identify those populations at greater risk.

Design, setting, and participants: This was a cross-sectional epidemiologic evaluation conducted using deidentified data from the large federated TriNetX Analytics health research network composed of 56 health care organizations in the US. Patients from 2015 to 2022 who had an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code of type 1 DR (T1DR) or type 2 DR (T2DR) were included in this analysis. Patients were further stratified by age cohorts (20-29 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years, and 70 years or older), race and ethnicity, and sex.

Main outcomes and measures: Prevalence per 100 000 patients and prevalence odds ratios (ORs) were calculated in Microsoft Excel and Posit (formerly RStudio).

Results: A total of 359 126 patients with T1DR or T2DR (mean [SD] age, 67 [14] years; 52% female) were included in this study between January 1, 2015, and December 21, 2022. T1DR increased in prevalence from 2015 to 2022, with T1DR increasing 1.15-fold affecting 70.4 patients per 100 000 in 2022. T2DR increased 1.07-fold affecting 461.7 patients per 100 000 in 2022. For T1DR, the cohort aged 20 to 39 years had the most substantial increase at 4.7 and 1.96 fold. Overall, White males had the largest prevalence ORs of T1DR at 1.41 (95% CI, 1.36-1.47) compared with White females (reference group). In T2DR, patients aged 20 to 39 years again had a 2.5- and 1.6-fold prevalence increase from 2015 to 2022. Regardless of age group, Hispanic males demonstrated larger prevalence OR at 4.08 (95% CI, 3.97-4.19) compared with White females followed by Hispanic females at 2.49 (95% CI, 2.42-2.56), Black males at 2.23 (95% CI, 2.17-2.29), and Black females at 2.00 (95% CI, 1.95-2.05).

Conclusion and relevance: The prevalence of both T1DR and T2DR increased in this network from 2015 to 2022, with individuals aged 20 to 39 years showing large increases. Additionally, T2DR was associated with greater increases in both Hispanic and Black communities. These findings support DR screening in young adults and for T2DR interventions specifically designed for racial and ethnic minoritized patients most affected by disease. Future investigations are warranted to further investigate these trends among young adults.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Talcott reported receiving consultant fees from Alimera, Apellis, Bausch and Lomb, Eyepoint, and Genentech; speaker’s fees from Iveric Bio and Genentech; and research fees from Regeneron, Regenxbio, and Zeiss research. Dr Singh reported receiving personal fees from Genentech/Roche, Alcon, Novartis, Regeneron, Asclepix, Gyroscope, Bausch and Lomb, and Apellis during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Prevalence of Type 1 Diabetic Retinopathy From 2015 to 2022 Stratified by Race and Ethnicity and Sex (per 100 000)
Figure 2.
Figure 2.. Prevalence of Type 1 Diabetic Retinopathy From 2015 to 2022 Stratified by Age, Race and Ethnicity, and Sex (per 100 000)
Figure 3.
Figure 3.. Prevalence of Type 2 Diabetic Retinopathy From 2015 to 2022 Stratified by Race and Ethnicity and Sex (per 100 000)
Figure 4.
Figure 4.. Prevalence of Type 2 Diabetic Retinopathy From 2015 to 2022 Stratified by Age, Race and Ethnicity, and Sex (per 100 000)
Figure 5.
Figure 5.. Prevalence Odds Ratios (ORs) of Having Type 1 or Type 2 Diabetic Retinopathy in 2022
See this image and copyright information in PMC

Comment on

References

    1. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet. 2010;376(9735):124-136. doi: 10.1016/S0140-6736(09)62124-3 - DOI - PubMed
    1. Middleton TL, Constantino MI, Molyneaux L, et al. Young-onset type 2 diabetes and younger current age: increased susceptibility to retinopathy in contrast to other complications. Diabet Med. 2020;37(6):991-999. doi: 10.1111/dme.14238 - DOI - PMC - PubMed
    1. Wong J, Molyneaux L, Constantino M, Twigg SM, Yue DK. Timing is everything: age of onset influences long-term retinopathy risk in type 2 diabetes, independent of traditional risk factors. Diabetes Care. 2008;31(10):1985-1990. doi: 10.2337/dc08-0580 - DOI - PMC - PubMed
    1. Zou W, Ni L, Lu Q, et al. Diabetes onset at 31-45 years of age is associated with an increased risk of diabetic retinopathy in type 2 diabetes. Sci Rep. 2016;6(1):38113. doi: 10.1038/srep38113 - DOI - PMC - PubMed
    1. Barsegian A, Kotlyar B, Lee J, Salifu MO, McFarlane SI. Diabetic retinopathy: focus on minority populations. Int J Clin Endocrinol Metab. 2017;3(1):34-45. doi: 10.17352/ijcem.000027 - DOI - PMC - PubMed