Racial and Ethnic Differences in Prevalence and Incidence of Diabetic Retinal Disease

PURPOSE: To determine prevalence and incidence trends of diabetic retinal disease (DRD) and its vision-threatening forms over the last 20 years among patients with diabetes mellitus (DM) among US racial and ethnic groups. METHODS: A retrospective cohort study of members of commercial and Medicare Advantage health plans between 2000 and 2022 was conducted, with cohorts of White(W), Black/African American(B/AA), Hispanic(H), and Asian(A) DM patients identified using ICD-9/10 codes. Outcomes included annual prevalence and incidence of DRD, diabetic macular edema (DME), and proliferative diabetic retinopathy (PDR). Multivariable logistic and Poisson regression models analyzed trends in prevalence odds ratios and incidence rate ratios, respectively. RESULTS: B/AA patients had higher prevalence rates of DRD every year analyzed compared with White patients (2021 B/AA:23.1%; W:19.0%; p<0.001). Both Hispanic (2001 H:12.3%) and Asian (2001:11.9%) patients initially had lower DRD prevalence than White patients (2001:13.1%; p<0.001 for both); both are now higher with Hispanic patients having the highest rates (2021 H:26.0%; A:21.2%;W:19.0%, p<0.001). DME and PDR prevalence increased across all groups through 2015/2016, then decreased through 2021 (2021 DME:W:4.5%, B/AA:5.9%; H:5.9%, A:4.7%; 2021 PDR:W:2.9%, B/AA:4.3%, H:5.0%, A:2.9%).Since 2009, incidence rates for DRD, DME, and PDR in Hispanic and B/AA patients have been higher than for White patients (IRR=1.08-1.85; p<0.001 for all comparisons). Asian patients initially had higher DRD incidence rates than White patients, but that difference disappeared in 2021 before increasing again in 2022 (2022 IRR=1.07, 95%CI=1.01-1.14). CONCLUSION: Disparities in prevalence and incidence of DRD, DME, and PDR persist for B/AA and have worsened for Hispanic patients.