Diabetic Retinopathy Disease Burden in Patients With Lower Household Incomes vs Higher Household Incomes

Area of Science:

• Ophthalmology
• Public Health
• Socioeconomic Determinants of Health

Background:

• Diabetic retinopathy (DR) is a leading cause of vision loss.
• Socioeconomic status may influence access to care and disease burden.
• Understanding disparities in DR presentation is crucial for targeted interventions.

Purpose of the Study:

• To compare diabetic retinopathy (DR) disease burden in patients from low-income versus high-income ZIP codes.
• To identify differences in clinical presentation and treatment needs at the time of retina specialist evaluation.

Main Methods:

• Retrospective cohort study of patients managed for DR at Duke Eye Center (2014-2023).
• Comparison of the lowest income quartile versus the highest income quartile.
• Analysis of demographic and clinical data, including glycosylated hemoglobin A1c (HbA1c), visual acuity (VA), DR stage, diabetic macular edema (DME), and need for intervention.

Main Results:

• Patients in low-income ZIP codes were more likely to present with diabetic macular edema (DME) (P<.01).
• Low-income patients had more severe DR (P<.001) and required intervention more often (P<.001).
• Visual acuity was worse in the low-income group, though not statistically significant (P<.10).

Conclusions:

• Low-income patients present with more severe diabetic retinopathy (DR), higher prevalence of DME, and greater need for treatment.
• These findings indicate potential barriers to care for low-income individuals before specialist evaluation.
• Addressing socioeconomic disparities is essential to improve outcomes for diabetic eye disease.