Disparities Observed in Diabetic Retinopathy Rates By Gender, Ethnicity

Jacqueline K. Shaia, MS

David C Kaelber, MD, PhD, MPH

New findings suggest an increase in odds of diabetic retinopathy (DR) in Black individuals with type 2 diabetes compared to white individuals, while Black women saw an increase in all types of DR compared to Black men.

“Further research is needed to understand why these differences exist,” wrote study authors Jacqueline K. Shaia, MS, Case Western Reserve University and David C Kaelber, MD, PhD, MPH, The MetroHealth System.

These data were presented at the Association of Research in Vision and Ophthalmology (ARVO) 2022 Meeting in Denver, Colorado.

As a leading cause of blindness that affects nearly one-third of the diabetic population worldwide, DR is expected to continue to grow in prevalence. Estimates project 16 million Americans will be affected by the condition by the year 2050.

The goal of the current study was to complete a descriptive study of patients with DR in the United States, using information from the TriNetX database, a combined electronic health record database of over 50 systems.

Patients with type 1 and type 2 DR were identified utilizing encounter ICD codes in the TriNetX database. Investigators collected data on demographics, average body mass index (BMI), and average glycated hemoglobin A1c values. Additionally, proportions, percentages, and chi-squares were thus calculated to evaluate type 1 and type 2 DR.

Of the 74 million patients, a total of 0.11% and 6.1% had type 1 or type 2 diabetes, respectively. From the patients identified in the TriNetX database, data show 9.3% of patients with type 1 and 7.1% of patients with type 2 had DR.

When investigators compared ethnicity among individuals with type 2 DR, the odds of DR among those who were Black was 1.41 times the odds of DR among patients who were White (95% CI, 1.40 - 1.42).

However, they found the opposite disparity among patients with type 1 DR who were Black, with 0.96 times the odds of DR among those who were White (95% CI, 0.94 - 0.97).

Regarding the odds of Black women having type 2 DR, they were 1.04 times more likely to have DR than Black men (95% CI, 1.03 - 1.05). Data show similar numbers in type 1 DR patients where Black women were also more likely than Black men to have DR with an odds ratio of 1.08 (95% CI, 1.04 - 1.12).

If comparing men and women who were White had type 2 DR, the odds ratio indicated no difference between gender (95% CI, 0.99 - 1.01). On the other hand, for type 1 DR, the odds of being White and a woman were 1.04 (95% CI, 1.04 - 1.06).

The odds of having type 1 or type 2 diabetes without DR among White women was 0.79 and 0.80 times the odds compared to White men. The comparison of HbA1c levels and BMI showed no significant differences between gender or ethnicity.

The study, “A Descriptive Study of Diabetic Retinopathy Disparities among Millions of Patients,” was presented at ARVO 2022.