Racial and Ethnic Disparities in Risk for Adverse Ocular Events in Patients With Diabetic Retinopathy

Diabetic retinopathy (DR) is a major cause of blindness in the United States. Given this potential impact, identifying racial and ethnic disparities in DR-related adverse ocular events is essential for developing equitable interventions. This study aims to assess disparities in the risk of adverse visual outcomes by race and ethnicity among patients with DR in the United States from 2005 to 2025.

Retrospective cohort study.

The study analyzed aggregated, deidentified electronic medical records of 627,434 patients diagnosed with DR between 2005 and 2025, stratified by race and ethnicity. The primary outcomes were the incidence of adverse visual outcomes including blindness, vitreous hemorrhage (VH), tractional retinal detachment (TRD), and diabetic macular edema (DME) within 1 year and 5 years following DR diagnosis.

Black patients exhibited higher risks of all adverse visual outcomes studied including the following 1-year outcomes: blindness absolute event rate (AER) = 3278 vs 2498, risk ratio (RR) = 1.34, VH AER = 3739 vs 2736, RR = 1.37, TRD AER = 2448 vs 1159, RR = 2.13, and DME AER = 6379 vs 5308, RR = 1.22; and 5-year outcomes: blindness AER = 8513 vs 6201, RR = 1.40, VH AER = 7509 vs 6104, RR = 1.23, TRD AER = 4145 vs 2026, RR = 2.07, and DME AER = 12,268 vs 10,867, RR = 1.15. Hispanic patients similarly faced higher risks of adverse visual outcomes including the following 1-year outcomes: blindness AER = 2244 vs 1416, RR = 1.64, VH AER = 3646 vs 1625, RR = 2.35, TRD AER = 2017 vs 804, RR = 2.52, and DME AER = 5543 vs 3106, RR = 1.63; and 5-year outcomes: blindness AER = 5371 vs 3412, RR = 1.63, VH AER = 6677 vs 3506, RR = 1.99, TRD AER = 3175 vs 1319, RR = 2.43, and DME AER = 9635 vs 5955, RR = 1.48.

This study reveals significant racial and ethnic disparities in adverse visual outcomes among patients with DR, with Black and Hispanic patients facing higher risks of severe complications that persisted even when controlling for baseline disease severity. These findings can be used to guide targeted public health interventions to reduce disparities and to improve care for affected populations.