Unequal Referral Patterns to Ophthalmology Subspecialists Based on Race and Ethnicity in Diabetes Mellitus: A Retrospective Analysis

Katherine Guerra O’Neill,1 Seth E Buscho,1 Biai Dominique Elmir Digbeu,2 Zachary Dezeeuw,3 Kevin H Merkley,3 Praveena K Gupta3 1John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA; 2Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA; 3Department of Ophthalmology & Visual Sciences, University of Texas Medical Branch, Galveston, TX, USACorrespondence: Praveena K Gupta, Department of Ophthalmology & Visual Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0144, USA, Tel +1 617 416 0825, Email [email protected]: Previous research has shown that racial disparities exist regarding the prevalence of and associated vision loss from diabetic retinopathy. Unfortunately, little is known about potential racial and ethnic disparities of diabetic eye exam referral patterns by primary care providers. Understanding referral patterns to ophthalmic specialists is key to understanding the steps needed to prevent progression of this vision-threatening condition, particularly in minority populations.Patients and Methods: Patients who were diagnosed with type II diabetes mellitus (DM) at a tertiary medical center between 2015 and 2023 were retrospectively identified from the electronic medical record (n = 10,995). Patient demographics, comorbidities, presence or absence of ophthalmology referral, HbA1c and insulin dependence at time of referral, time from referral to first ophthalmic appointment, as well as diabetic retinopathy presence/stage at first ophthalmic exam after referral were collected.Results: Of the white patients who were diagnosed with DM, 79.3% were referred for ophthalmology screening, compared to 78.55% of Hispanic patients (RR: 1.03 [95% CI: 0.92, 1.15]) and 75.75% of black patients (RR: 0.83 [95% CI: 0.74, 0.93]) (p = 0.0009). 56.38% of White patients had a HbA1c ≥ 7% at referral compared to 61.33% of Hispanic patients (RR: 1.16 [95% CI: 1.00, 1.34]) and 53.48% of Black patients (RR 0.86 [95% CI: 0.73, 1.01]) (p = 0.0004). 5.69% of referred white patients were diagnosed with diabetic retinopathy compared to 10.22% of Black patients (RR: 1.88 [95% CI 1.58, 2.23) and 10.91% of Hispanic patients (RR: 1.58 [95% CI 1.32, 1.89]) (p < 0.0001).Conclusion: Black patients were less likely to receive an ophthalmology referral at the time of DM diagnosis, and Hispanic patients were more likely to be referred at a more severe HbA1c compared to white patients. Both black and Hispanic patients were more likely to be diagnosed with diabetic retinopathy at first ophthalmic appointment than white patients.Keywords: diabetes mellitus, race, ethnicity, referrals, diabetic retinopathy