CoChat
Sign Up
Cited by 293Retinal Diseases and TreatmentsRetinal Imaging and AnalysisDiabetes Management and Research

Prevalence of Diabetic Retinopathy in the US in 2021

Open access
Lundeen, Elizabeth A., Burke-Conte, Zeb, Rein, David B., Wittenborn, John S., Saaddine, Jinan, Lee, Aaron Y., Flaxman, Abraham D.·2023·JAMA Ophthalmology
DOI 10.1001/jamaophthalmol.2023.2289PMC PMC10273133
Open this paper in CoChat — free account

Abstract

Importance: Diabetic retinopathy (DR) is a common microvascular complication of diabetes and a leading cause of blindness among working-age adults in the US. Objective: To update estimates of DR and vision-threatening diabetic retinopathy (VTDR) prevalence by demographic factors and US county and state. Data Sources: The study team included data from the National Health and Nutrition Examination Survey (2005 to 2008 and 2017 to March 2020), Medicare fee-for-service claims (2018), IBM MarketScan commercial insurance claims (2016), population-based studies of adult eye disease (2001 to 2016), 2 studies of diabetes in youth (2021 and 2023), and a previously published analysis of diabetes by county (2012). The study team used population estimates from the US Census Bureau. Study Selection: The study team included relevant data from the US Centers for Disease Control and Prevention’s Vision and Eye Health Surveillance System. Data Extraction and Synthesis: Using bayesian meta-regression methods, the study team estimated the prevalence of DR and VTDR stratified by age, a nondifferentiated sex and gender measure, race, ethnicity, and US county and state. Main Outcomes and Measures: The study team defined individuals with diabetes as those who had a hemoglobin A 1c level at 6.5% or more, took insulin, or reported ever having been told by a physician or health care professional that they have diabetes. The study team defined DR as any retinopathy in the presence of diabetes, including nonproliferative retinopathy (mild, moderate, or severe), proliferative retinopathy, or macular edema. The study team defined VTDR as having, in the presence of diabetes, severe nonproliferative retinopathy, proliferative retinopathy, panretinal photocoagulation scars, or macular edema. Results: This study used data from nationally representative and local population-based studies that represent the populations in which they were conducted. For 2021, the study team estimated 9.60 million people (95% uncertainty interval [UI], 7.90-11.55) living with DR, corresponding to a prevalence rate of 26.43% (95% UI, 21.95-31.60) among people with diabetes. The study team estimated 1.84 million people (95% UI, 1.41-2.40) living with VTDR, corresponding to a prevalence rate of 5.06% (95% UI, 3.90-6.57) among people with diabetes. Prevalence of DR and VTDR varied by demographic characteristics and geography. Conclusions and Relevance: US prevalence of diabetes-related eye disease remains high. These updated estimates on the burden and geographic distribution of diabetes-related eye disease can be used to inform the allocation of public health resources and interventions to communities and populations at highest risk.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamaophthalmol.2023.2289

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • African-American patients are 1.6 times more likely to present with vision-threatening diabetic retinopathy as compared to non-Hispanic Whites.

    “For example, African-American patients are three times more likely to present with diabetic macular edema (DME), 1.6 times more likely to present with vision-threatening diabetic retinopathy, and 4 times more likely to present with vision loss as compared to non-Hispanic Whites9–12.”

    From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [11]

    The Results report age- and sex-standardized vision-threatening diabetic retinopathy prevalence of 8.66% among non-Hispanic Black individuals and 3.55% among non-Hispanic White individuals. The paper describes Black prevalence as 155.50% higher, not 1.6 times as high. It measures prevalence among people with diabetes, not likelihood of presenting with the condition. (LLM, conf=0.90)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • The 8% prevalence of referable DR mirrors the real-world scenario within the Lifeline Express Program, while the 4% prevalence was chosen based on data from high-income countries and the 12% prevalence was based on data from other LMICs.

    “The 8% prevalence mirrors the real-world scenario within the Lifeline Express Program, while the lower prevalence of 4% was chosen based on data from high-income countries55,56, and the higher prevalence of 12% was based on data from other LMICs57–59.”

    From Economic evaluation for medical artificial intelligence: accuracy vs. cost-effectiveness in a diabetic retinopathy screening case (2024) · cites this paper as [55]

    The citation is attached to the 4% high-income-country benchmark, not the Lifeline Express or LMIC figures. The Introduction reports 4.4% vision-threatening diabetic retinopathy among US adults aged 40 or older with diabetes, and the Results estimate 5.06% in the US in 2021. These provide an approximate US benchmark, but the paper does not identify either figure as the prevalence of referable diabetic retinopathy or say that 4% was chosen from its data. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • African-American patients are three times more likely to present with diabetic macular edema (DME) as compared to non-Hispanic Whites.

    “For example, African-American patients are three times more likely to present with diabetic macular edema (DME), 1.6 times more likely to present with vision-threatening diabetic retinopathy, and 4 times more likely to present with vision loss as compared to non-Hispanic Whites9–12.”

    From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [11]

    The Introduction (page unavailable) identifies DME as one form of vision-threatening diabetic retinopathy (VTDR). The Results (page unavailable) report higher VTDR prevalence among Black than White people with diabetes, but do not report a separate DME comparison or support the claimed threefold difference in DME. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • The study simulated prevalences of referable DR of 4%, 8%, and 12% to reflect global variations.

    “To accommodate different DR screening settings, we simulated at WTP levels ranging from US$ 0 to 30,828, and different prevalences of referable DR (4%, 8%, and 12%) to reflect the global variations.”

    From Economic evaluation for medical artificial intelligence: accuracy vs. cost-effectiveness in a diabetic retinopathy screening case (2024) · cites this paper as [55]

    The Methods describe a meta-regression estimating US prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy, and the Results report US prevalence estimates. Our copy does not address a simulation using 4%, 8%, and 12% referable-retinopathy prevalences to reflect global variation; searches for those values, referable retinopathy, and screening simulations found no such passage. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • African-American patients are 4 times more likely to present with vision loss as compared to non-Hispanic Whites.

    “For example, African-American patients are three times more likely to present with diabetic macular edema (DME), 1.6 times more likely to present with vision-threatening diabetic retinopathy, and 4 times more likely to present with vision loss as compared to non-Hispanic Whites9–12.”

    From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [11]

    The Results report higher vision-threatening diabetic retinopathy prevalence among Black than White people with diabetes (8.66% versus 3.55%), but do not report a racial comparison for vision loss. A search for the claimed fourfold vision-loss difference found no such estimate in our copy; vision-threatening retinopathy is not the same outcome as vision loss. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

The citation lists haven’t been fetched yet

References 38 · Cited by 293

Research works printed but not linked: 31

  1. [2]Klein R, Klein BEK. Vision disorders in diabetes. [Chapter 14] In: Diabetes in America. 2nd ed. 1995:293-338. [Google Scholar]
  2. [5]Jampol LM, Glassman AR, Sun J. Evaluation and care of patients with diabetic retinopathy. N Engl J Med. 2020;382(17):1629-1637. doi: 10.1056/NEJMra1909637 [DOI] [PubMed] [Google Scholar] · DOI
  3. [6]Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a systematic review. JAMA. 2007;298(8):902-916. doi: 10.1001/jama.298.8.902 [DOI] [PubMed] [Google Scholar] · DOI
  4. [7]Varma R, Torres M, Peña F, Klein R, Azen SP; Los Angeles Latino Eye Study Group . Prevalence of diabetic retinopathy in adult Latinos: the Los Angeles Latino eye study. Ophthalmology. 2004;111(7):1298-1306. doi: 10.1016/j.ophtha.2004.03.002 [DOI] [PubMed] [Google Scholar] · DOI
  5. [8]Kempen JH, O’Colmain BJ, Leske MC, et al. The prevalence of diabetic retinopathy among adults in the United States. Ophthalmol. Arch Ophthalmol. 2004;122(4):552-563. doi: 10.1001/archopht.122.4.552 [DOI] [PubMed] [Google Scholar] · DOI
  6. [12]Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. JAMA. 2015;314(10):1021-1029. doi: 10.1001/jama.2015.10029 [DOI] [PubMed] [Google Scholar] · DOI · Paper page
  7. [13]Wang L, Li X, Wang Z, et al. Trends in prevalence of diabetes and control of risk factors in diabetes among US adults, 1999-2018. 2021;326(8):704-716. doi: 10.1001/jama.2021.9883 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  8. [14]Flaxman AD, Vos DT, Murray CJ. An Integrative Metaregression Framework for Descriptive Epidemiology. University of Washington Press; 2015. [Google Scholar]
  9. [15]Varma R, Wen G, Jiang X, et al. ; Chinese American Eye Study Group . Prevalence of diabetic retinopathy in adult Chinese American individuals: The Chinese American Eye Study. JAMA Ophthalmol. 2016;134(5):563-569. doi: 10.1001/jamaophthalmol.2016.0445 [DOI] [PubMed] [Google Scholar] · DOI
  10. [17]Wong TY, Klein R, Islam FM, et al. Diabetic retinopathy in a multi-ethnic cohort in the United States. Am J Ophthalmol. 2006;141(3):446-455. doi: 10.1016/j.ajo.2005.08.063 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  11. [18]Kovarik JJ, Eller AW, Willard LA, Ding J, Johnston JM, Waxman EL. Prevalence of undiagnosed diabetic retinopathy among inpatients with diabetes: the diabetic retinopathy inpatient study (DRIPS). BMJ Open Diabetes Res Care. 2016;4(1):e000164. doi: 10.1136/bmjdrc-2015-000164 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  12. [19]Levitsky LL, Danis RP, Drews KL, et al. ; TODAY Study Group . Retinopathy in youth with type 2 diabetes participating in the TODAY clinical trial. Diabetes Care. 2013;36(6):1772-1774. doi: 10.2337/dc12-2387 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  13. [20]Bjornstad P, Drews KL, Caprio S, et al. ; TODAY Study Group . Long-term complications in youth-onset type 2 diabetes. N Engl J Med. 2021;385(5):416-426. doi: 10.1056/NEJMoa2100165 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  14. [21]Gubitosi-Klug R, Libman I, Drews KL, et al. ; TODAY Study Group . Development and progression of diabetic retinopathy in adolescents and young adults with type 2 diabetes: results from the TODAY study. Diabetes Care. 2021;45(5):1049-1055. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. [22]Mayer-Davis EJ, Davis C, Saadine J, et al. ; SEARCH for Diabetes in Youth Study Group . Diabetic retinopathy in the SEARCH for Diabetes in Youth Cohort: a pilot study. Diabet Med. 2012;29(9):1148-1152. doi: 10.1111/j.1464-5491.2012.03591.x [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  16. [23]Jensen ET, Rigdon J, Rezaei KA, et al. Prevalence, progression and modifiable risk factors for diabetic retinopathy in youth and young adults with youth-onset type 1 and type 2 diabetes: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2023:dc222503. doi: 10.2337/dc22-2503 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  17. [27]Zheng P, Barber R, Sorensen RJ, Murray CJ, Aravkin AY. Trimmed constrained mixed effects models: formulations and algorithms. Accessed May 9, 2023. https://arxiv.org/abs/1909.10700 · arXiv
  18. [32]Lin J, Thompson TJ, Cheng YJ, et al. Projection of the future diabetes burden in the United States through 2060. Popul Health Metr. 2018;16(1):9. doi: 10.1186/s12963-018-0166-4 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  19. [33]Dwyer-Lindgren L, Mackenbach JP, van Lenthe FJ, Flaxman AD, Mokdad AH. Diagnosed and undiagnosed diabetes prevalence by county in the US, 1999–2012. Diabetes Care. 2016;39(9):1556-1562. doi: 10.2337/dc16-0678 [DOI] [PubMed] [Google Scholar] · DOI
  20. [37]Fang M, Wang D, Coresh J, Selvin E. Trends in diabetes treatment and control in U.S. adults, 1999-2018. N Engl J Med. 2021;384(23):2219-2228. doi: 10.1056/NEJMsa2032271 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  21. [38]Lundeen EA, Andes LJ, Rein DB, et al. Trends in prevalence and treatment of diabetic macular edema and vision-threatening diabetic retinopathy among Medicare part B fee-for-service beneficiaries. JAMA Ophthalmol. 2022;140(4):345-353. doi: 10.1001/jamaophthalmol.2022.0052 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  22. [39]Lopez JM, Bailey RA, Rupnow MF. Demographic disparities among Medicare beneficiaries with type 2 diabetes mellitus in 2011: diabetes prevalence, comorbidities, and hypoglycemia events. Popul Health Manag. 2015;18(4):283-289. doi: 10.1089/pop.2014.0115 [DOI] [PubMed] [Google Scholar] · DOI
  23. [40]Saydah S, Cowie C, Eberhardt MS, De Rekeneire N, Narayan KM. Race and ethnic differences in glycemic control among adults with diagnosed diabetes in the United States. Ethn Dis. 2007;17(3):529-535. [PubMed] [Google Scholar]
  24. [41]Heisler M, Faul JD, Hayward RA, Langa KM, Blaum C, Weir D. Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study. Arch Intern Med. 2007;167(17):1853-1860. doi: 10.1001/archinte.167.17.1853 [DOI] [PubMed] [Google Scholar] · DOI
  25. [42]Harris MI, Eastman RC, Cowie CC, Flegal KM, Eberhardt MS. Racial and ethnic differences in glycemic control of adults with type 2 diabetes. Diabetes Care. 1999;22(3):403-408. doi: 10.2337/diacare.22.3.403 [DOI] [PubMed] [Google Scholar] · DOI
  26. [43]Wang MC, Shah NS, Carnethon MR, O’Brien MJ, Khan SS. Age at diagnosis of diabetes by race and ethnicity in the United States from 2011 to 2018. JAMA Intern Med. 2021;181(11):1537-1539. doi: 10.1001/jamainternmed.2021.4945 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI
  27. [44]Canedo JR, Miller ST, Schlundt D, Fadden MK, Sanderson M. Racial/ethnic disparities in diabetes quality of care: the role of healthcare access and socioeconomic status. J Racial Ethn Health Disparities. 2018;5(1):7-14. doi: 10.1007/s40615-016-0335-8 [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI · Paper page
  28. [46]Ferris FL III, Davis MD, Aiello LM. Treatment of diabetic retinopathy. N Engl J Med. 1999;341(9):667-678. doi: 10.1056/NEJM199908263410907 [DOI] [PubMed] [Google Scholar] · DOI
  29. [47]Caird FI, Burditt AF, Draper GJ. Diabetic retinopathy. a further study of prognosis for vision. Diabetes. 1968;17(3):121-123. doi: 10.2337/diab.17.3.121 [DOI] [PubMed] [Google Scholar] · DOI
  30. [48]Deckert T, Simonsen SE, Poulsen JE. Prognosis of proliferative retinopathy in juvenile diabetics. Diabetes. 1967;16(10):728-733. doi: 10.2337/diab.16.10.728 [DOI] [PubMed] [Google Scholar] · DOI
  31. [49]Wittenborn JS, Gu Q, Erdem E, et al. The prevalence of diagnosis of major eye diseases and their associated payments in the Medicare fee-for-service program. Ophthalmic Epidemiol. 2021;16:1-13. doi: 10.1080/09286586.2021.1968006 [DOI] [PubMed] [Google Scholar] · DOI

Authors
Lundeen, E. A., Burke-Conte, Z., Rein, D. B., Wittenborn, J. S., Saaddine, J., Lee, A. Y., & Flaxman, A. D.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • University of Washington (US)
  • University of Chicago (US)
Corresponding author
Lundeen, Elizabeth A.
ORCID
Venue
JAMA Ophthalmology
Publisher
American Medical Association (AMA)
Published
2023-08-01
Volume
141
Issue
8
Pages
747
ISSN
2168-6165 (ISSN-L)
DOI
10.1001/jamaophthalmol.2023.2289
PMC
PMC10273133
OpenAlex
W4380729858
Cited by
293
References
38
Citations by year
2026: 102 · 2025: 111 · 2024: 69 · 2023: 9 · 2019: 1 · 2016: 1
FWCI
70.81
Type
journal article
Language
en
Open access
Locations
  • JAMA Ophthalmology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Center for Chronic Disease Prevention and Health Promotion (U01 DP006444)
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, vision-threatening diabetic retinopathy, prevalence, diabetes mellitus, blindness, non-proliferative diabetic retinopathy, proliferative diabetic retinopathy, diabetic macular edema, racial and ethnic disparities, regional variation, sex differences, age differences, HbA1c, Medicare claims data, insurance claims, United States
MeSH terms
Adolescent, Adult, Aged, Bayes Theorem, Cross-Sectional Studies, Diabetes Mellitus, Diabetic Retinopathy, Female, Medicare, Humans, Macular Edema, Male, Nutrition Surveys, Retinal Diseases, Risk Factors, United States, Prevalence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review