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Cited by 94Retinal Diseases and TreatmentsHealth disparities and outcomesOphthalmology and Visual Impairment Studies

Racial Disparity of Eye Examinations Among the U.S. Working-Age Population With Diabetes: 2002–2009

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Shi, Qian, Zhao, Yingnan, Fonseca, Vivian, Krousel-Wood, Marie, Shi, Lizheng·2014·Diabetes Care
DOI 10.2337/dc13-1038PMC PMC4876755
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Abstract

OBJECTIVE: Diabetes care differs across racial and ethnic groups. This study aimed to assess the racial disparity of eye examinations among U.S. adults with diabetes. RESEARCH DESIGN AND METHODS: Working-age adults (age 18–64 years) with diabetes were studied using data from the Medical Expenditure Panel Survey Household Component (2002–2009) including the Diabetes Care Survey. Racial and ethnic groups were classified as non-Hispanic whites and minorities. People reporting one or more dilated eye examination were considered to have received an eye examination in a particular year. Eye examination rates were compared between racial/ethnic groups for each year, and were weighted to national estimates. Multivariate adjusted odds ratios (aORs) and 95% CIs for racial/ethnic difference were assessed annually using logistic regression models. Other influencing factors associated with eye examination were also explored. RESULTS: Whites had consistently higher unadjusted eye examination rates than minority populations across all 8 years. The unadjusted rates increased from 56% in 2002 to 59% in 2009 among whites, while the rates in minorities decreased from 56% in 2002 to 49% in 2009. The largest significant racial gap of 15% was observed in 2008, followed by 11%, 10%, and 7% in 2006, 2009, and 2005, respectively (P < 0.05). Minorities were less likely to receive eye examination (2006: aOR 0.75 [95% CI 0.57–0.99]; 2008: 0.61 [0.45–0.84]). CONCLUSIONS: The racial/ethnic differences in eye examinations for patients with diabetes have persisted over the last decade. National programs to improve screening and monitoring of diabetic retinopathy are needed to target minority populations.

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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 [8]

    The Conclusions (Summary; page unavailable) report lower eye-examination rates among racial and ethnic minority patients with diabetes, and the Introduction reports higher diabetic-retinopathy prevalence in some minority groups. The paper does not establish that the care gap causes worse outcomes in under-resourced communities, and it does not address DED prevalence if DED means dry eye disease. Its Study Limitations state that the cross-sectional analysis could not establish causality. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • African-American patients with diabetes are less likely to undergo annual screening exams for DR.

    “African-American patients with diabetes are less likely to undergo annual screening exams for DR4–7.”

    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 [6]

    The Methods define receipt of an eye examination as at least one dilated examination in a year, and the Results report lower rates for minority patients than for non-Hispanic white patients. However, the study groups minorities together rather than reporting an African-American-specific finding, and its sample is limited to working-age adults with diabetes (18–64 years). (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Minority populations overall have consistently lower unadjusted eye examination rates than White populations.

    “In fact, minority populations overall have consistently lower unadjusted eye examination rates than White populations17.”

    From Autonomous artificial intelligence for diabetic eye disease increases access and health equity in underserved populations (2024) · cites this paper as [17]

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Cited by

Sorted by citations

Authors
Shi, Q., Zhao, Y., Fonseca, V., Krousel-Wood, M., & Shi, L.
Affiliations
  • Tulane University (US)
  • Xavier University of Louisiana (US)
Corresponding author
Shi, Lizheng
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2014-04-10
Volume
37
Issue
5
Pages
1321-1328
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc13-1038
PMC
PMC4876755
OpenAlex
W2157841439
Cited by
94
References
2
Citations by year
2026: 8 · 2025: 10 · 2024: 15 · 2023: 10 · 2022: 12 · 2021: 7 · 2020: 7 · 2019: 6 · 2018: 3 · 2017: 6 · 2016: 4 · 2015: 5 · 2014: 1
FWCI
5.00
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Care (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
National Institute of General Medical Sciences (U54GM104940)
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Epidemiology › Ophthalmology and Visual Impairment Studies
Keywords
racial disparities, diabetic eye examination, diabetic retinopathy screening, ethnic minorities, working-age adults, health care utilization, diabetes monitoring, Medical Expenditure Panel Survey
MeSH terms
Adolescent, Adult, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Retinopathy, Ethnicity, Health Services Needs and Demand, Humans, Middle Aged, Minority Groups, Physical Examination, Research Design, United States, Vision Screening, Health Care Surveys, Early Diagnosis, Young Adult

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