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

Zhang, Xinzhi MD, PhD
Saaddine, Jinan B. MD, MPH
Chou, Chiu-Fang DrPH
Cotch, Mary Frances PhD
Cheng, Yiling J. MD, PhD
Geiss, Linda S. MA
Gregg, Edward W. PhD
Albright, Ann L. PhD, RD
Klein, Barbara E. MD, MPH
Klein, Ronald MD, MPH

Author Affiliations: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Zhang, Saaddine, Chou, Cheng, Geiss, Gregg, and Albright); Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD (Dr Cotch); Department of Ophthalmology and Visual Sciences, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin (Drs B. Klein and R. Klein).

Corresponding Author: Xinzhi Zhang MD, PhD, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE (K-10), Atlanta, GA 30341-3727 ([email protected]).

Author Contributions: Dr Zhang had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Zhang, Saaddine, Cotch, Cheng, Albright.

Acquisition of data: Chou, Cotch, Cheng, Albright, B. Klein, R. Klein.

Analysis and interpretation of data: Zhang, Saaddine, Chou, Cotch, Cheng, Geiss, Gregg, Albright.

Drafting of the manuscript: Zhang, Cheng, R. Klein.

Critical revision of the manuscript for important intellectual content: Saaddine, Chou, Cotch, Cheng, Geiss, Gregg, Albright, B. Klein, R. Klein.

Statistical analysis: Zhang, Chou, Cheng, R. Klein.

Administrative, technical, or material support: Zhang, Saaddine, Cotch, Geiss, R. Klein.

Study supervision: Saaddine, Gregg, Albright, R. Klein.

Financial Disclosures: None reported.

Funding/Support: This study was supported by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC). Funding for the National Health and Nutrition Examination Survey (NHANES) retinal component was provided by the Intra Agency Agreement 05FED47304 from the Division of Diabetes Translation, CDC. Funding for the vision component was provided by the National Eye Institute, National Institutes of Health, Intramural Research Program grant Z01EY000402.

Role of the Sponsor:The NCHS was involved in the design and conduct of the NHANES study and in data collection, but was not involved in the analysis or interpretation of the study results or in the preparation of the manuscript. The Division of Diabetes Translation provided funding support for the retinal component and was involved in the design and conduct of the study; in the collection, analysis, and interpretation of the data; and in the preparation, review, and approval of this article before submission.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the CDC.

Additional Contributions: We gratefully acknowledge the important statistical contribution of Theodore J. Thompson, MS, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Mr Thompson did not receive compensation in association with his contribution to this article. We also thank the NHANES participants without whom this study would not be possible.

JAMA: The Journal of the American Medical Association 304(6):p 649-656, August 11, 2010.

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 [CI], 24.9%-32.5%) and 4.4% (95% CI, 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% CI, 26.8%-36.8%; vs 25.7%; 95% CI, 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% CI, 31.9%-46.1%; vs 26.4%; 95% CI, 21.4%-32.2%; P = .01) and vision-threatening diabetic retinopathy (9.3%; 95% CI, 5.9%-14.4%; vs 3.2%; 95% CI, 2.0%-5.1%; P = .01). Male sex was independently associated with the presence of diabetic retinopathy (odds ratio [OR], 2.07; 95% CI, 1.39-3.10), as well as higher hemoglobin A_1c level (OR, 1.45; 95% CI, 1.20-1.75), longer duration of diabetes (OR, 1.06 per year duration; 95% CI, 1.03-1.10), insulin use (OR, 3.23; 95% CI, 1.99-5.26), and higher systolic blood pressure (OR, 1.03 per mm Hg; 95% CI, 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.