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Cited by 1,196Retinal Diseases and TreatmentsRetinal Imaging and AnalysisDiabetes Management and Research

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

Open access
Zhang, Xinzhi, Saaddine, Jinan B., Chou, Chiu-Fang, Cotch, Mary Frances, Cheng, Yiling J., Geiss, Linda S., Gregg, Edward W., Albright, Ann L. +2 more·2010·JAMA
DOI 10.1001/jama.2010.1111PMC PMC2945293
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Abstract

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.

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  • This care gap is a major source of health disparity, with racial and ethnic minorities, and under-resourced communities, having worse outcomes, and a disproportionately higher prevalence of DED.

    “This care gap is a major source of health disparity, with racial and ethnic minorities, and under-resourced communities, having worse outcomes, and a disproportionately higher prevalence of DED2,5–9.”

    From Autonomous artificial intelligence increases screening and follow-up for diabetic retinopathy in youth: the ACCESS randomized control trial (2024) · cites this paper as [2]

    The Results report higher prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy among non-Hispanic Black and Mexican American individuals with diabetes than among non-Hispanic White individuals (page not provided). The Comment suggests that differences in screening and treatment may contribute, but does not establish the care gap as a major cause. The paper does not report DED prevalence or show worse outcomes in under-resourced communities. (LLM, conf=0.86)

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Authors
Zhang, X., Saaddine, J. B., Chou, C.-F., Cotch, M. F., Cheng, Y. J., Geiss, L. S., Gregg, E. W., Albright, A. L., Klein, B. E. K., & Klein, R.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Zhang, Xinzhi
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2010-08-11
Volume
304
Issue
6
Pages
649
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2010.1111
PMC
PMC2945293
OpenAlex
W2049036672
Cited by
1,196
References
41
Citations by year
2026: 26 · 2025: 62 · 2024: 83 · 2023: 109 · 2022: 82 · 2021: 131 · 2020: 104 · 2019: 91 · 2018: 71 · 2017: 70 · 2016: 66 · 2015: 81 · 2014: 62 · 2013: 65 · 2012: 59
FWCI
55.13
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (Z99 EY999999)
  • U.S. Public Health Service (05FED47304)
  • National Eye Institute (ZIAEY000402, Z01EY000402)
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
diabetic retinopathy, prevalence, vision-threatening diabetic retinopathy, diabetes mellitus, risk factors, sex differences, racial disparities, non-Hispanic Black adults, fundus photography, adults aged 40 and older, United States adults
MeSH terms
Adult, Aged, Black or African American, Cross-Sectional Studies, Diabetic Retinopathy, Female, Humans, Male, Middle Aged, Nutrition Surveys, Risk Factors, United States, Vision Disorders, Prevalence

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