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

Purpose: To assess the differences in measures of diabetic retinopathy (DR) disease burden between patients in high-income vs low-income ZIP codes when presenting to retina specialists. Methods: This retrospective cohort study comprised patients who presented to a retina specialist at Duke Eye Center between 2014 and 2023 for the management of DR. The quartile of patients with the highest income was compared with the quartile with the lowest income. Demographic data included age, sex, and race. Clinical data included glycosylated hemoglobin A_1c (HbA_1c), visual acuity (VA), DR diagnostic stage, presence of diabetic macular edema (DME) or vitreous hemorrhage, and whether treatment was indicated. Measures of DR disease burden included HbA_1c, VA, presence of DME or vitreous hemorrhage, severity of DR, and need for intervention. Results: The analysis included 430 eyes of 215 patients. After controlling for age, sex, race, and glycemic control, it was found that patients in the low-income group were more likely to have DME at presentation (P < .01), to have more severe DR at presentation (P < .001), and to require an intervention for DR (P < .001). The VA was worse in the low-income group than in the high-income group (20/50 vs 20/32; P < .10); however, this did not reach statistical significance. Conclusions: Patients living in low-income ZIP codes have greater DR severity, a higher prevalence of DME, and need for treatment than their high-income counterparts when first presenting to a retina specialist. These findings suggest that patients from low-income backgrounds may face additional barriers before being evaluated by a retina specialist, resulting in more clinically advanced stages of DR at presentation.