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Impact of Prior Diabetic Retinal Screening on Hospitalization and Ophthalmic Follow-Up in Diabetic Patients with
Charles Zhang1,2, Neel R Sonik3, Zoe J Tsoukas3
1Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine, University of Miami, 900 NW 17th Street, Miami, FL 33136, USA.
Insights
Patients with newly diagnosed proliferative diabetic retinopathy (PDR) without prior screening had higher hospitalization rates and fewer follow-up eye exams. This highlights gaps in healthcare engagement and disease control for diabetic retinopathy patients.
Area of Science:
- Ophthalmology
- Public Health
- Health Services Research
Background:
- Diabetic retinopathy (DR) screening is crucial for early detection and management of vision-threatening complications.
- Proliferative diabetic retinopathy (PDR) is an advanced stage of DR requiring timely intervention.
- Understanding the impact of prior screening on healthcare utilization for newly diagnosed PDR is essential for optimizing patient outcomes.
Purpose of the Study:
- To compare hospitalization and ophthalmic follow-up rates in patients with newly diagnosed PDR with and without prior diabetic retinopathy screening.
- To identify potential disparities in healthcare engagement associated with DR screening history.
Main Methods:
- Retrospective cohort study utilizing the TriNetX electronic health record database.
- Included 57,964 patients aged ≥ 40 years with type 2 diabetes and newly diagnosed PDR without diabetic macular edema.
- Propensity score matching (PSM) was used to balance cohorts based on prior DR screening status (within 5 years).
Main Results:
- Patients without prior DR screening exhibited significantly higher hospitalization rates at 30, 60, and 90 days post-diagnosis (RR 1.51-1.78).
- These patients also had significantly lower rates of repeat ophthalmic visits, assessed by PDR diagnosis codes and retinal imaging codes (RR 0.38-0.46).
- All findings were statistically significant (p < 0.0001).
Conclusions:
- Absence of prior DR screening in PDR patients is linked to increased hospitalization risk and decreased follow-up care.
- This suggests broader issues with healthcare engagement and disease management in this population.
- Targeted interventions are necessary to improve screening adherence, prevent vision loss, and manage systemic complications.
Abstract:
Background/Objectives: This retrospective cohort study compared hospitalization and follow-up rates in patients with newly diagnosed proliferative diabetic retinopathy (PDR) versus those without prior diabetic retinopathy (DR) screening. Methods: Using TriNetX, a global electronic health record database, 57,964 patients aged ≥ 40 years with type 2 diabetes and newly diagnosed PDR without diabetic macular edema (DME) requiring panretinal photocoagulation or intravitreal injection were included. Patients were stratified based on the presence or absence of prior DR screening in the last 5 years and balanced using propensity score matching (PSM). Primary outcomes included 30-, 60-, and 90-day hospitalization rates and repeat ophthalmic follow-up as estimated using repeat PDR diagnosis codes and repeat retinal imaging codes, including OCT, fundus photography, and fluorescein angiography. Results: Of 57,964 patients, 25,003 had no prior DR screening and 32,961 had prior DR screening. After matching, 19,316 patients were included per cohort. Patients without known DR screening had significantly higher hospitalization rates at 30 days (RR = 1.78, 95% CI 1.67-1.89), 60 days (RR = 1.59, 95% CI 1.51-1.67), and 90 days (RR = 1.51, 95% CI 1.44-1.58), and lower repeat ophthalmic visits by PDR codes at 30 days (RR = 0.458, 95% CI 0.440-0.476), 60 days (RR = 0.450, 95% CI 0.437-0.463) and 90 days (RR = 0.420, 95% CI 0.408-0.432) or by repeat retinal imaging codes at 30 days (RR = 0.450, 95% CI 0.423-0.478), 60 days (RR = 0.394, 95% CI 0.377-0.411), and 90 days (RR = 0.381, 95% CI 0.366-0.396) (all p < 0.0001). Conclusions: Absence of known prior DR screening in PDR patients is associated with higher hospitalization risk and reduced ophthalmic follow-up, suggesting that a lack of screening indicates broader gaps in healthcare engagement and disease control. Tailored strategies are needed to prevent vision loss as well as systemic complications.
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