June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Racial and Ethnic Differences in Receipt of Retinal Imaging Among Patients with Diabetes
Yvette Schein; Diep Tran; Scott Zeger; Cindy Cai
Author Affiliations & Notes
  • Yvette Schein
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Diep Tran
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Scott Zeger
    Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Cindy Cai
    Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Yvette Schein None; Diep Tran None; Scott Zeger None; Cindy Cai None
  • Footnotes
    Support  This project was supported by a Career Development Award from the Research to Prevent Blindness (CXC), National Center for Advancing Translational Sciences funded Clinical and Translational Science Award (Grant KL2TR003099, CXC), K23 award from the NIH/NEI (award number K23EY033440, CXC), and an unrestricted grant from Research to Prevent Blindness (Wilmer Eye Institute). Dr. Cai is the Jonathan and Marcia Javitt Rising Professor of Ophthalmology. This project was also supported by the Wilmer Eye Institute Ophthalmology Research and Innovation award (YS)
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 2277. doi:
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      Yvette Schein, Diep Tran, Scott Zeger, Cindy Cai; Racial and Ethnic Differences in Receipt of Retinal Imaging Among Patients with Diabetes. Invest. Ophthalmol. Vis. Sci. 2023;64(8):2277.

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Abstract

Purpose : Retinal imaging is integral to the diagnosis and management of diabetic eye disease. This study evaluates whether there are racial and ethnic differences in the receipt of retinal imaging among patients with diabetes.

Methods : This was a retrospective cohort study of patients with diabetes ≥18 years seen at a single academic institution from 2013-2022. The primary outcome was whether retinal imaging was ordered (macular optical coherence tomography (OCT), fundus photo, fluorescein (FA) or indocyanine green (ICG) angiography). Hierarchical logistic regression models clustered on the provider level were fit using generalized estimating equations with robust variance to evaluate the association between race/ethnicity and receipt of retinal imaging, controlling for sociodemographic, ocular, and health care access characteristics.

Results : Of 31,510 patients, 6,520 (21%) received retinal imaging. 2708 (9%) had fundus photos, 2029 (6%) had FA/ICG, and 6223 (20%) had OCT. In multivariable analyses, Hispanic patients (OR 0.72, p=0.002) and those classified as other (OR 0.65, p<0.001) had lower odds of receiving retinal imaging when compared with otherwise similar non-Hispanic White patients. Non-Hispanic Black patients (OR 1.15, p = 0.029) had higher odds of receiving retinal imaging. We also observed differences in receipt of retinal imaging by healthcare access. Those with Medicare (OR 0.78, p<0.001) or no insurance (OR 0.66, p=0.025) had lower odds of receiving imaging compared to those with private insurance, while those on Medicaid had higher (OR 1.2, p=0.041). Patients seen at a satellite office (OR 0.75, p<0.001), and those not seen by a retinal specialist (OR 0.27, p<0.001) also had lower odds of receiving retinal imaging.

Conclusions : We observed racial and ethnic differences in receipt of retinal imaging even controlling for sociodemographic, ocular, and health care access characteristics. As retinal imaging becomes increasingly important in the diagnosis and management of diabetic eye diseases, it will be crucial to understand where barriers to receipt of retinal imaging might exist to help ensure more equitable practice going forward.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Table 1: Characteristics of patients with diabetes stratified by race and ethnicity.
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Table 1: Characteristics of patients with diabetes stratified by race and ethnicity.

Table 1: Characteristics of patients with diabetes stratified by race and ethnicity.

Table 1: Characteristics of patients with diabetes stratified by race and ethnicity.
View OriginalDownload Slide
 
Table 2: Hierarchical logistic regression models evaluating factors associated with receipt of retinal imaging.
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Table 2: Hierarchical logistic regression models evaluating factors associated with receipt of retinal imaging.

Table 2: Hierarchical logistic regression models evaluating factors associated with receipt of retinal imaging.

Table 2: Hierarchical logistic regression models evaluating factors associated with receipt of retinal imaging.
View OriginalDownload Slide

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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Copyright © 2024 Association for Research in Vision and Ophthalmology.
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