Racial and Socioeconomic Differences Correlate with Healthcare Disparities in Patients with Diabetic Retinopathy

Abstract

Diabetic retinopathy (DR), an ocular complication of diabetes mellitus, is the leading cause of permanent blindness in the United States for young adults. Due to biological and environmental factors, diabetes mellitus is well known to disproportionally affect people of color and those of lower socioeconomic status; however, the racial and socioeconomic disparities of DR are less researched. The purpose of this research is to elucidate any differences in DR presentation that arise across racial and socioeconomic lines and to determine if diabetic control can be a predicting factor for DR severity. For this study, a retrospective patient chart analysis was performed on 511 consecutive newly referred patients with diabetes at New England Retina Associates, a vitreo-retinal ophthalmology practice with four locations throughout Connecticut. Our analysis shows that, when compared to their White and Asian counterparts, Black/African American and Hispanic patients present with DR at younger ages, had the higher HbA1c, were uninsured at higher rates, and presented with severe forms of DR in higher rates when compared to their counterparts. Many of these patterns are mirrored in patients that are uninsured or on Medicaid, indicators of lower socioeconomic status. Additionally, regardless of race or socioeconomic status, patients with higher HbA1c tended to present with more severe forms of DR. These findings indicate that DR disproportionately affects racial minority populations and those in socioeconomically disadvantageous positions, but effective glycemic control and routine eye exam screening can improve the outcomes of these patients. It is important for medical providers to recognize the disparities in these vulnerable populations in order to facilitate the timely referrals and the proper care for their long-term ocular health.