Unequal Referral Patterns to Ophthalmology Subspecialists Based on Race and Ethnicity in Diabetes Mellitus: A Retrospective Analysis.

Clinical ophthalmology (Auckland, N.Z.) Pub Date : 2025-05-17 eCollection Date: 2025-01-01 DOI:10.2147/OPTH.S519979
Katherine Guerra O'Neill, Seth E Buscho, Biai Dominique Elmir Digbeu, Zachary Dezeeuw, Kevin H Merkley, Praveena K Gupta
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Abstract

Purpose: Previous research has shown that racial disparities exist regarding the prevalence of and associated vision loss from diabetic retinopathy. Unfortunately, little is known about potential racial and ethnic disparities of diabetic eye exam referral patterns by primary care providers. Understanding referral patterns to ophthalmic specialists is key to understanding the steps needed to prevent progression of this vision-threatening condition, particularly in minority populations.

Patients and methods: Patients who were diagnosed with type II diabetes mellitus (DM) at a tertiary medical center between 2015 and 2023 were retrospectively identified from the electronic medical record (n = 10,995). Patient demographics, comorbidities, presence or absence of ophthalmology referral, HbA1c and insulin dependence at time of referral, time from referral to first ophthalmic appointment, as well as diabetic retinopathy presence/stage at first ophthalmic exam after referral were collected.

Results: Of the white patients who were diagnosed with DM, 79.3% were referred for ophthalmology screening, compared to 78.55% of Hispanic patients (RR: 1.03 [95% CI: 0.92, 1.15]) and 75.75% of black patients (RR: 0.83 [95% CI: 0.74, 0.93]) (p = 0.0009). 56.38% of White patients had a HbA1c ≥ 7% at referral compared to 61.33% of Hispanic patients (RR: 1.16 [95% CI: 1.00, 1.34]) and 53.48% of Black patients (RR 0.86 [95% CI: 0.73, 1.01]) (p = 0.0004). 5.69% of referred white patients were diagnosed with diabetic retinopathy compared to 10.22% of Black patients (RR: 1.88 [95% CI 1.58, 2.23) and 10.91% of Hispanic patients (RR: 1.58 [95% CI 1.32, 1.89]) (p < 0.0001).

Conclusion: Black patients were less likely to receive an ophthalmology referral at the time of DM diagnosis, and Hispanic patients were more likely to be referred at a more severe HbA1c compared to white patients. Both black and Hispanic patients were more likely to be diagnosed with diabetic retinopathy at first ophthalmic appointment than white patients.

基于种族和民族的糖尿病眼科专科医生的不平等转诊模式:回顾性分析。
目的:先前的研究表明,在糖尿病视网膜病变的患病率和相关视力丧失方面存在种族差异。不幸的是,人们对初级保健提供者在糖尿病眼科检查转诊模式中潜在的种族差异知之甚少。了解眼科专家的转诊模式是了解预防这种视力威胁疾病进展所需步骤的关键,特别是在少数民族人群中。患者和方法:回顾性分析2015年至2023年间在三级医疗中心诊断为II型糖尿病(DM)的患者(n = 10,995)。收集患者人口统计学、合并症、是否有眼科转诊、转诊时的糖化血红蛋白和胰岛素依赖、转诊至首次眼科预约的时间,以及转诊后首次眼科检查的糖尿病视网膜病变存在/分期。结果:在被诊断为糖尿病的白人患者中,79.3%的患者接受了眼科筛查,而西班牙裔患者的这一比例为78.55% (RR: 1.03 [95% CI: 0.92, 1.15]),黑人患者的这一比例为75.75% (RR: 0.83 [95% CI: 0.74, 0.93]) (p = 0.0009)。56.38%的白人患者转诊时HbA1c≥7%,而西班牙裔患者为61.33% (RR: 1.16 [95% CI: 1.00, 1.34]),黑人患者为53.48% (RR 0.86 [95% CI: 0.73, 1.01]) (p = 0.0004)。5.69%的白人患者被诊断为糖尿病视网膜病变,而黑人患者的这一比例为10.22% (RR: 1.88 [95% CI 1.58, 2.23]),西班牙裔患者的这一比例为10.91% (RR: 1.58 [95% CI 1.32, 1.89]) (p < 0.0001)。结论:与白人患者相比,黑人患者在诊断为糖尿病时接受眼科转诊的可能性较小,西班牙裔患者在HbA1c更严重时接受转诊的可能性更大。黑人和西班牙裔患者在第一次眼科预约时比白人患者更容易被诊断为糖尿病视网膜病变。
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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