Twenty year trends in prevalence and incidence of diabetic retinal disease.

Abstract

Objective: To determine how the rates of diabetic retinal disease (DRD) and its vision-threatening components (VTDR), diabetic macular edema (DME), and proliferative diabetic retinopathy (PDR) among patients with diabetes mellitus (DM) have changed over the past 20 years.

Design: Retrospective cohort study.

Subjects: All individuals in a US administrative medical claims database comprised of patients insured by commercial and Medicare Advantage insurance plans from 2000-2022 with DM and at least one full calendar year of data. Cohorts of patients with DM were created using ICD codes to determine the yearly prevalence and incidence of DRD, VTDR DME, and PDR.

Methods: Logistic and Poisson regression models were used to create prevalence and incidence estimates, respectively.

Main outcome measure: The main outcomes were the unadjusted prevalence and incidence of DRD, DME, and PDR.

Results: Among patients with DM, the prevalence of DRD initially decreased from 2001 (13.6%) to 2007 (10.9%) but then increased every year through 2021 (20.8%)(adjusted test for trend[aTT] p<0.001). DRD incidence varied considerably, ranging from 17.7 cases/1000 patient-years in 2013 to its highest of 32.2 in 2022 (aTT p<0.001). The prevalence of VTDR and DME trended similarly, with increases from 2007 (VTDR:5.2%; DME:3.2%) through 2016 (VTDR:7.5%; DME:5.4%) followed by decreases each year through 2021 (VTDR:6.9%; DME:4.9%)(aTT p<0.001). The VTDR and DME incidence rates also tracked similarly, with multi-year peaks in 2009 (VTDR:12.4; DME:8.6) and general decreases through 2022 (VTDR:6.1; DME:5.0)(aTT p<0.001 for both VTDR and DME). PDR prevalence varied between 3.2% and 4.0% throughout the 20-year observation, measuring 3.5% in 2021(aTT p<0.001). PDR incidence varied from 8.3 in 2002 to 7.0 in 2008, then decreased every year to 2.6 in 2022 (aTT p<0.001).

Conclusions and relevance: DRD Prevalence (through 2007) and incidence (through 2014) initially decreased, but the rate of each has since doubled. Despite increases in DRD, incidence rates of VTDR, DME, and PDR have dramatically improved over the past 20 years.