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Epidemiology of Retinopathy of Prematurity in the US From 2003 to 2019
Anshul Bhatnagar1, Henry C Skrehot1, Amit Bhatt2
1School of Medicine, Baylor College of Medicine, Houston, Texas.
Insights
Retinopathy of prematurity (ROP) incidence increased in US premature infants from 2003-2019, disproportionately affecting Black, Hispanic, and low-income populations. These findings highlight ROP as a growing public health concern requiring targeted interventions.
Area of Science:
- Ophthalmology
- Neonatal Care
- Public Health Epidemiology
Background:
- Retinopathy of prematurity (ROP) is a significant cause of vision impairment in premature infants.
- The epidemiology of ROP is not well-defined, necessitating research into at-risk populations for targeted interventions.
- Understanding trends in ROP incidence is crucial for developing effective prevention and detection strategies.
Purpose of the Study:
- To analyze changes in the incidence of Retinopathy of prematurity (ROP) among premature infants in the United States between 2003 and 2019.
- To identify specific subpopulations, including those based on race, ethnicity, socioeconomic status, and geographic location, that are disproportionately affected by ROP.
- To inform public health initiatives and clinical practices for ROP prevention and management.
Main Methods:
- A retrospective database cohort study utilizing the Healthcare Cost and Utilization Project Kids' Inpatient Databases (2003-2019).
- Inclusion criteria focused on pediatric newborns identified with International Classification of Diseases codes for ROP.
- Statistical analyses, including chi-squared tests of independence, were employed to assess incidence variations over time and across subpopulations.
Main Results:
- The overall incidence of ROP among premature infants increased from 4.4% in 2003 to 8.1% in 2019.
- Significant increases in ROP incidence were observed among Black (5.8% to 11.6%) and Hispanic (4.6% to 8.2%) infants.
- Infants from the lowest income quartile consistently showed the highest ROP incidence, with a notable increase from 4.9% to 9.0%. The Southern US also experienced the greatest proportional growth in ROP diagnoses.
Conclusions:
- ROP incidence has significantly increased among US premature infants between 2003 and 2019, with notable disparities.
- Black, Hispanic, and infants from lower socioeconomic backgrounds face a disproportionately higher and increasing burden of ROP.
- The findings underscore the growing public health challenge of ROP and the urgent need for targeted strategies to address health inequities.
Importance:
Retinopathy of prematurity (ROP) is a potentially blinding retinal disease with poorly defined epidemiology. Understanding of which infants are most at risk for developing ROP may foster targeted detection and prevention efforts.
Objective:
To identify changes in ROP incidence in the US from 2003 to 2019.
Design, Setting, And Participants:
This retrospective database cohort study used the Healthcare Cost and Utilization Project Kids' Inpatient Databases. These nationwide databases are produced every 3 years, include data from over 4000 hospitals, and are designed to generate national estimates of health care trends in the US. Participants included pediatric newborns at risk for ROP development between 2003 and 2019. Data were analyzed from September 30, 2021, to January 13, 2022.
Exposures:
Premature or low-birth-weight infants with relevant International Classification of Diseases, Ninth Revision or Tenth Revision codes were considered ROP candidates. Infants with ROP were identified using relevant codes.
Main Outcomes And Measures:
ROP incidence in selected subpopulations (based on database-reported race and ethnicity, sex, location, income) was measured. To determine whether incidences varied across time or subpopulations, χ2 tests of independence were used.
Results:
This study included 125 212 ROP discharges (64 715 male infants [51.7%]) from 23 187 683 births. The proportion of premature infants diagnosed with ROP increased from 4.4% (11 720 of 265 650) in 2003 to 8.1% (27 160 of 336 117) in 2019. Premature infants from the lowest median household income quartile had the greatest proportional increase of ROP diagnoses from 4.9% (3244 of 66 871) to 9.0% (9386 of 104 235; P < .001). Premature Black infants experienced the largest increase from 5.8% (2124 of 36 476) to 11.6% (7430 of 63 925; P < .001) relative to other groups (2.71%; 95% CI, 2.56%-2.87%; P < .001). Hispanic infants experienced the second largest increase from 4.6% (1796 of 39 106) to 8.2% (4675 of 57 298; P < .001) relative to other groups (-0.16%; 95% CI, -0.29% to -0.03%; P = .02). The Southern US experienced the greatest proportional growth of ROP diagnoses, increasing from 3.7% (3930 of 106 772) to 8.3% (11 952 of 144 013; P < .001) relative to other groups (1.61%; 95% CI, 1.51%-1.71%; P < .001). ROP diagnoses proportionally increased in urban areas and decreased in rural areas.
Conclusions And Relevance:
This cohort study found that ROP incidence among premature infants increased from 2003 to 2019, especially among Black and Hispanic infants. Infants from the lowest-income areas persistently had the highest proportional incidence of ROP, and all regions experienced a significant increase in ROP incidence with the most drastic changes occurring in the South. These trends suggest that ROP is a growing problem in the US and may be disproportionately affecting historically marginalized groups.
