Abstract
Purpose :
Diabetic retinopathy (DR) is a leading cause of preventable blindness in the United States. As such, there is a need for evidence-based policy solutions to reduce the burden of disease. To determine the influence of insurance type on DR outcomes, we conducted a retrospective longitudinal cohort study to observe trends in disease progression of Non-Proliferative Diabetic Retinopathy (NPDR) to Proliferative Diabetic Retinopathy (PDR).
Methods :
The study includes participants who were seen by an ophthalmologist at the Yale Medical Eye Center or the Dana Eye Clinic from January 1, 2013 to April 1, 2020 with a diagnosis of NDPR during their initial visit. Insurance and age were coded by their status upon initial visit. Insurance type was split into 5 categories: Private, Uninsured, Medicaid, Medicare, and Medicare Managed Care. Private was defined as plans provided through employers, self, community organizations or third-party administrators. Participants <18 years of age or with any diagnosis of PDR prior to or on their initial visit were excluded from the study. Progression to PDR was characterized as at least one PDR diagnosis during the study timeframe. We performed univariate and multivariate regressions to calculate the odds of NPDR to PDR progression. R-programming language was utilized for statistical analysis.
Results :
Of the 1,364 participants in the study, 137 progressed from NPDR to PDR in the time frame. When controlling for race/ethnicity, English as a primary language, age, and access to a primary care physician, uninsured participants with NPDR were significantly more likely to progress to PDR when compared to privately insured participants (OR: 2.18 CI:1.09-4.35, p= 0.028). A similar association remained in uninsured participants with NPDR compared to those with Medicare (OR: 3.12 CI: 1.51, p=0.002). On univariate analysis, participants with Medicaid were significantly more likely to progress to PDR when compared to participants with Medicare (OR: 1.91 CI: 1.17-3.11, p=0.010). However, the association no longer remained statistically significant upon multivariate analysis.
Conclusions :
Lack of insurance remained significantly associated with increased likelihood of NPDR to PDR progression, even when controlling for other PDR risk factors. Thus, these results indicate that health insurance expansion may be a direct avenue to decreasing preventable blindness in the United States.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.