Prevalence of Diabetic Retinopathy in US Remains High, Expected to Increase

Elizabeth A. Lundeen, PhD

Credit: LinkedIn

New research suggests the prevalence of diabetic eye diseases, including diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR), remains high and is expected to grow in the coming decades due to the increasing burden of diabetes.¹

The analysis estimated that 9.6 million people in the US had DR (approximately 1 in 4 of those with diabetes) and 1.84 million people (approximately 1 in 20 of those with diabetes) had VTDR in 2021.

“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,” wrote the investigative team, led by Elizabeth A. Lundeen, PhD, from the US Centers for Disease Control and Prevention (CDC).

DR is a common microvascular diabetes complication and is a leading cause of blindness among working-age adults in the US. Single-source estimates of the national prevalence exist in the CDC’s Vision and Eye Health Surveillance System (VEHSS), including the 2005 - 2008 National Health and Nutrition Examination Survey (NHANES). Based on these data, the prevalence of DR and VTDR was thought to be 28.5% and 4.4%, respectively, among adults ≥40 years with diabetes.²

Lundeen and colleagues suggested the importance of developing new multisource composite estimates of the US prevalence, as previous estimates could not reflect changes in population demographics or diabetes prevalence in the time that has since past. Lundeen and the team additionally noted the documented increase in diabetes prevalence has likely influenced the number of people living with DR.¹

“It has been projected that, by 2060, 60.6 million US adults (17.9%) will have diabetes, increasing the number of people living with diabetes complications, such as vision loss from DR,” the team wrote. “Forecasting studies project a nearly 3-fold increase in the number of individuals in the US with DR (from 5.5 million to 16.0 million) and VTDR (from 1.2 million to 3.4 million) between 2005 and 2050.”

For this analysis, the investigative team used bayesian meta-analytic methods to create composite estimates of the prevalence of DR and VTDR by age, nondifferentiated sex, and gender, demographic factors, and US county and state. Data were included from the NHANES 2005 - 2008 and 2017 - March 2020, Medicare fee-for-service claims (2018), IBM MarketScan commercial insurance claims (2016), population-based studies of adult eye disease (2001 - 2016), the Treatment Options for T2D in Adolescents and Youth (TODAY) study (2010 - 2018), the SEARCH for Diabetes in Youth registry study (2010 - 2019), and a previously published analysis of diabetes by county (2012). To estimate prevalence counts of DR and VTDR, investigators used 2021 US Census Bureau population estimates stratified by age, sex, race, and county.

Upon analysis, investigators estimated 9.6 million people (95% uncertainty interval [UI], 7.90 - 11.55) living with DR in the US in 2021. This corresponded to a prevalence rate of 26.43% (95% UI, 21.95 - 31.60) among people with diabetes. The team estimated 5.56 million individuals with male sex and gender and 4.04 million individuals with female sex and gender living with DR.

Additionally, the age- and sex and gender-standardized rates of DR among Hispanic individuals (29.21%) and Black individuals (34.39%) were found higher than the rates among White individuals (24.40%). Data showed the prevalence of DR increased as a function of age before declining in the oldest age group, from 13.01% among those younger than 25 years to 27.15% among those aged 40 - 64 years to 28.38% among those 65 - 79 years, and 24.81% among those ≥80 years. Lundeen and colleagues indicated the standardized rates of DR among the total population varied by US county.

Moreover, the investigative 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 those with diabetes. The analysis estimated 1.05 million individuals with male sex and gender and 0.78 million individuals with female sex and gender living with VTDR.

Age- and sex and gender-standardized rates of VTDR were higher among Hispanic individuals (7.14%) and Black individuals (8.66%), than among White individuals (3.55%). The prevalence of VTDR was shown to increase as a function of age until 65 - 69 years and saw a decline afterward. Again, investigators noted the standardized prevalence of VTDR in the total population varied by US county.

“These estimates can inform the allocation of public health resources and interventions to communities and populations at highest risk, such as expanding teleretinal imaging to improve DR screening in counties with the highest prevalence,” investigators wrote.

References

1. Lundeen EA, Burke-Conte Z, Rein DB, et al. Prevalence of Diabetic Retinopathy in the US in 2021. JAMA Ophthalmol. Published online June 15, 2023. doi:10.1001/jamaophthalmol.2023.2289
2. ZhangX, SaaddineJB, ChouCF,et al.Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2010;304(6):649-656. doi:10.1001/jama.2010.1111