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Racial/Ethnic Disparities Exist in Eye Care for Patients with Diabetes

An analysis of Medical Expenditure Panel Survey data suggests minority patients were less likely to undergo recommended exams and more likely to develop diabetic eye complications than their White counterparts.

New research from the University of Houston College of Pharmacy details significant disparities in eye care for patients with diabetes in the US.

An analysis of US Medical Expenditure Panel Survey data from 2009 through 2018, results of the study suggest minority patients were more likely than their White counterparts to experience ophthalmic complications and were also less likely to receive routine diabetic eye exams or participate in diabetes education programs.

“Among diabetic patients, Whites were more likely to receive routine diabetic eye exams than minorities. Moreover, compared to Hispanics, Whites reported a higher participation rate in clinical services and diabetes self-management education," said lead investigator Jieni Li, a doctoral student at the UH College of Pharmacy, in a statement.

With diabetes representing the leading cause of new, preventable cases of blindness among adults in the US, major organizations, including the American Diabetes Association, American Academy of Ophthalmology, and American Academy of Optometry have advocated for a greater focus on strategies for prevention of diabetic eye disease. Despite these efforts, recent reports detail concerning lack of progress.

To assess contemporary trends in prevalence and risk factors of diabetic eye complications based on racial/ethnic background among patients in the US, Li and a team of colleagues designed their study as an analysis of data from the 2009-2018 Medicals Expenditures Panel Survey (MEPS) data. From MEPS, investigators identified a cohort of 8080 patients with diabetes for inclusion in their analyses.

For the purpose of analysis, investigators used multivariable logistic regression models to assess presence of diabetic eye complications, rates of dilated eye exam attendance, and completion of ADA recommended guidelines for diabetes care based on an individual’s racial/ethnic background.

Of the 8080 patients identified for inclusion, 1263 were identified as having diabetic eye complications. Of those with diabetic eye complications, 20.34% self-reported as Hispanic, 57.50% self-reported as White, and 22.16% self-reported as African American. Investigators pointed out Hispanic and African American patients had a lower education level, lower income level, and lower insurance enrollment rate compared to their White counterparts. Additionally, approximately 30% of White patients with diabetic eye complications followed and completed ADA-recommended guidelines for diabetes care, which investigators pointed out was significantly higher than the 26.75% observed for Hispanic patients and 23.49% observed for African American patients (P <.001).

In the multivariable model, results demonstrated Hispanic and African American patients were 1.63 and 1.61 times more likely to have diabetic eye complications compared to their White counterparts. Further analysis indicated African American patients were 29% less likely than their White counterparts to complete all of the ADA-recommended processes of diabetes care.

“Because diabetic eye complications are consequences of poorly managed diabetes over time, such racial/ethnic disparities in the prevalence of diabetic eye complications are likely entrenched in a more profound systemic inequality in health care access,” added study investigator Wendy Harrison, associate professor at the College of Optometry.

This study, “Disparity in diabetic eye complications among racial/ethnic minorities: An Analysis of the 2009-2018 United States Medical Expenditure Panel Survey,” was published in Diabetes Epidemiology and Management.