Prevalence of Diabetic Retinopathy in the United States, 2005-2008

Context The prevalence of diabetes in the United States has increased. People with diabetes are at risk for diabetic retinopathy. No recent national population-based estimate of the prevalence and severity of diabetic retinopathy exists. Objectives To describe the prevalence and risk factors of diabetic retinopathy among US adults with diabetes aged 40 years and older. Design, Setting, and Participants Analysis of a cross-sectional, nationally representative sample of the National Health and Nutrition Examination Survey 2005-2008 (N=1006). Diabetes was defined as a self-report of a previous diagnosis of the disease (excluding gestational diabetes mellitus) or glycated hemoglobin A(1c) of 6.5% or greater. Two fundus photographs were taken of each eye with a digital nonmydriatic camera and were graded using the Airlie House classification scheme and the Early Treatment Diabetic Retinopathy Study severity scale. Prevalence estimates were weighted to represent the civilian, noninstitutionalized US population aged 40 years and older. Main Outcome Measurements Diabetic retinopathy and vision-threatening diabetic retinopathy. Results The estimated prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was 28.5% (95% confidence interval [Cl], 24.9%-32.5%) and 4.4% (95% Cl, 3.5%-5.7%) among US adults with diabetes, respectively. Diabetic retinopathy was slightly more prevalent among men than women with diabetes (31.6%; 95% Cl, 26.8%-36.8%; vs 25.7%; 95% Cl, 21.7%-30.1%; P=.04). Non-Hispanic black individuals had a higher crude prevalence than non-Hispanic white individuals of diabetic retinopathy (38.8%; 95% Cl, 31.9%-46.1%; vs 26.4%; 95% Cl, 21.4%-32.2%; P=.01) and vision-threatening diabetic retinopathy (9.3%; 95% Cl, 5.9%-14.4%; vs 3.2%; 95% Cl, 2.0%-5.1%; P=.01). Male sex was independently associated with the presence of diabetic retinopathy (odds ratio [OR], 2.07; 95% Cl, 1.39-3.10), as well as higher hemoglobin A(1c) level (OR, 1.45; 95% Cl, 1.20-1.75), longer duration of diabetes (OR, 1.06 per year duration; 95% Cl, 1.03-1.10), insulin use (OR, 3.23; 95% Cl, 1.99-5.26), and higher systolic blood pressure (OR, 1.03 per mm Hg; 95% Cl, 1.02-1.03). Conclusion In a nationally representative sample of US adults with diabetes aged 40 years and older, the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was high, especially among Non-Hispanic black individuals. JAMA. 2010;304(6):649-656