Trends in Prevalence and Incidence of Diabetic Retinal Disease across Age Cohorts

Two recent studies have suggested that younger patients with diabetes mellitus (DM) are progressing to diabetic retinal disease (DRD) at higher rates than in previous years. This study aims to determine how the rates of DRD and vision-threatening diabetic retinopathy (VTDR), comprised of diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR), among patients with DM have changed across age groups over time.

Retrospective cohort study comprised of members of commercial and Medicare Advantage health plans between 2000 and 2022.

Cohorts of patients aged ≤25, 26 to 45, 46 to 64, and ≥65 years were created from all patients with DM identified using International Classification of Diseases 9/10 or ICD-9/10 codes.

Logistic and Poisson regression models were used to estimate prevalence and incidence, respectively.

The main outcomes were the unadjusted prevalence and incidence of DRD, VTDR, DME, and PDR.

Age cohorts remained proportional with respect to DRD prevalence (P) and incidence (I) over the 20 years analyzed. The ≤25 age cohort was always the lowest, followed by the 26 to 45, 46 to 64, and ≤65 cohorts, respectively (2001-2021 ≤25 P = 3.0%-4.5%; I = 5.1-11.1 [cases/1000-person-years]; 26-45 P = 6.3%-10.9%; I = 9.7-21.0; 46-64 P = 10.6%-15.7%; I = 14.7-30.9; ≥65 P = 13.2%-23.1%; I = 20.0-39.2). Similar proportional relationships were seen for VTDR and DME prevalence. However, VTDR and DME incidence saw differences with ≥65 age cohort (2022 VTDR I = 6.0 cases/1000 person-years; DME I = 5.0), ending lower than the 44 to 64 age cohort (2022 VTDR I = 7.1, DME = 5.5), whereas the 26 to 45 (2022 VTDR I = 4.7; DME I = 3.2) and ≤25 (2022 VTDR I = 2.0; DME I = 1.7) were the next lowest, respectively (P < 0.001 for all comparisons across age in 2022). Proliferative diabetic retinopathy prevalence was highest in the ≥65 cohort (3.7%) until 2021, when it became similar to the 46 to 64 age cohort (3.5%) (P = 0.40). Proliferative diabetic retinopathy incidence also declined significantly in ≥65 cohort (2022 I = 2.3) ending lower than 46 to 64 cohort (I = 3.8) and similar to the 26 to 44 cohort (I = 2.6), but still higher than the ≤25 cohort (I = 0.6) (P = 0.007 for ≥65 vs. ≤25 and P < 0.001 for ≥65 vs. 46-64; P = 0.07 for ≥65 vs. 26-45).

In contrast to recent studies, no evidence was found to suggest that DRD is progressing faster in those aged ≤25 years. Those aged ≥65 years saw significant declines in DRD prevalence and incidence over the observation period.

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