Sociodemographic disparities in diabetic retinopathy: Analysis of the 2021 behavioral risk factor surveillance system

AJO International Pub Date : 2025-04-18 DOI:10.1016/j.ajoint.2025.100127

Dawsyn Smith , S. Mackenzee Hester , Ryan Emmert , Juliana Bryant , Micah Hartwell

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Abstract

Purpose

To investigate and update the prevalence of diabetic retinopathy (DR) by age, race/ethnicity, sex, socioeconomic status, education, and rurality in the United States. Additionally, we aimed to address a gap in research by investigating the rates of DR among the transgender population.

Design

We conducted a cross-sectional study using data from the Behavioral Risk Factor Surveillance System, a phone-based survey conducted in the United States and surrounding territories by the Centers for Disease Control, and assessed the prevalence of DR by various sociodemographic factors.

Methods

A sample of 21,905 individuals was drawn from survey data based on self-reported diabetes status. We used X² tests to evaluate the prevalence of DR across sociodemographic factors, and a multivariable logistic regression model with all variables was used to determine adjusted odds ratios as a measure for sociodemographic associations.

Results

From the 21,905 participants, the prevalence of DR was lower in females (17.34 %) than males (20.14 %), though highest in transgender participants (27.16 %; P = 0.017). White individuals had the lowest prevalence of DR (16.57 %)—with all other groups exceeding 22 % (P<0.01). DR prevalence was inversely associated with income and educational attainment (P<0.01). The adjusted regression model shoowed significantly higher likelihoods for males (AOR = 1.33; 95%CI: 1.16-1.52) compared to females and for all racial groups compared to White individuals, with Asian Americans showing the highest odds (AOR = 2.08; 95%CI: 1.16-3.71). It also revealed lower odds with increasing income--those earning >$200,000 or more (AOR = 0.40; 95 % CI: 0.22 0.75)—and higher education, with college or technical school graduates (AOR = 0.74; 95 % CI: 0.58–0.95) compared to the lowest levels.

Conclusions

Our findings showed higher DR prevalence among all ethnoracial groups, males and transgender individuals, and lower income and education status. These disparities highlight the need for targeted screening and prevention efforts, including removing barriers and improving access to care and community education programs.

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糖尿病视网膜病变的社会人口统计学差异：2021年行为危险因素监测系统分析

目的调查并更新美国不同年龄、种族/民族、性别、社会经济地位、教育程度和乡村地区的糖尿病视网膜病变（DR）患病率。此外，我们还旨在通过调查变性人群中的糖尿病视网膜病变患病率来填补研究空白。设计我们利用行为风险因素监测系统的数据开展了一项横断面研究，该系统是美国疾病控制中心在美国及周边地区开展的一项电话调查，我们根据各种社会人口因素评估了糖尿病视网膜病变的患病率。方法我们根据自我报告的糖尿病状况从调查数据中抽取了 21905 人作为样本。我们使用 X2 检验来评估不同社会人口学因素的 DR 患病率，并使用包含所有变量的多变量逻辑回归模型来确定调整后的几率比，以衡量社会人口学关联性。结果在 21905 名参与者中，女性的 DR 患病率（17.34%）低于男性（20.14%），但变性者的患病率最高（27.16%；P = 0.017）。白种人的 DR 患病率最低（16.57%），其他群体均超过 22%（P<0.01）。DR患病率与收入和教育程度成反比（P<0.01）。调整回归模型显示，男性（AOR = 1.33；95%CI：1.16-1.52）的患病几率明显高于女性，所有种族群体的患病几率也明显高于白人，其中亚裔美国人的患病几率最高（AOR = 2.08；95%CI：1.16-3.71）。研究还显示，随着收入的增加，收入在 20 万美元或以上（AOR = 0.40; 95 % CI: 0.22 0.75）以及教育程度的提高，大学或技校毕业生（AOR = 0.74; 95 % CI: 0.58-0.95）的患病几率低于最低水平。这些差异凸显了有针对性的筛查和预防工作的必要性，包括消除障碍、改善就医途径和社区教育计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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AJO International

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