Lundeen Elizabeth A, Andes Linda J, Rein David B, Wittenborn John S, Erdem Erkan, Gu Qian, Saaddine Jinan, Imperatore Giuseppina, Chew Emily Y
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
NORC at the University of Chicago, Chicago, Illinois.
JAMA Ophthalmol. 2022 Apr 1;140(4):345-353. doi: 10.1001/jamaophthalmol.2022.0052.
While diabetes prevalence among US adults has increased in recent decades, few studies document trends in diabetes-related eye disease.
To examine 10-year trends (2009-2018) in annual prevalence of Medicare beneficiaries with diabetes with a diagnosis of diabetic macular edema (DME) or vision-threatening diabetic retinopathy (VTDR) and trends in treatment.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study using Centers for Medicare & Medicaid Services research identifiable files, data for patients 65 years and older were analyzed from claims. Beneficiaries were continuously enrolled in Medicare Part B fee-for-service (FFS) insurance for the calendar year and had a diagnosis of diabetes on 1 or more inpatient claims or 2 or more outpatient claims during the calendar year or a 1-year look-back period.
Using diagnosis and procedure codes, annual prevalence was determined for beneficiaries with 1 or more claims for (1) any DME, (2) either DME or VTDR, and (3) anti-vascular endothelial growth factor (VEGF) injections, laser photocoagulation, or vitrectomy, stratified by any DME, VTDR with DME, and VTDR without DME. Racial and ethnic disparities in diagnosis and treatment are presented for 2018.
In 2018, 6 960 823 beneficiaries (27.4%) had diabetes; half were aged 65 to 74 years (49.7%), half (52.7%) were women, and 75.7% were non-Hispanic White. From 2009 to 2018, there was an increase in the annual prevalence of beneficiaries with diabetes who had 1 or more claims for any DME (1.0% to 3.3%) and DME/VTDR (2.8% to 4.3%). Annual prevalence of anti-VEGF increased, particularly among patients with any DME (15.7% to 35.2%) or VTDR with DME (20.2% to 47.6%). Annual prevalence of laser photocoagulation decreased among those with any DME (45.5% to 12.5%), VTDR with DME (54.0% to 20.3%), and VTDR without DME (22.5% to 5.8%). Among all 3 groups, prevalence of vitrectomy in 2018 was less than half that in 2009. Prevalence of any DME and DME/VTDR was highest among Hispanic beneficiaries (5.0% and 7.0%, respectively) and Black beneficiaries (4.5% and 6.2%, respectively) and lowest among non-Hispanic White beneficiaries (3.0% and 3.8%, respectively). Among those with DME/VTDR, anti-VEGF was most prevalent among non-Hispanic White beneficiaries (30.3%).
From 2009 to 2018, prevalence of DME or VTDR increased among Medicare Part B FFS beneficiaries alongside an increase in anti-VEGF treatment and a decline in laser photocoagulation and vitrectomy.
近几十年来，美国成年人糖尿病患病率有所上升，但很少有研究记录糖尿病相关眼病的趋势。
研究2009年至2018年期间，患有糖尿病且被诊断为糖尿病性黄斑水肿（DME）或威胁视力的糖尿病视网膜病变（VTDR）的医疗保险受益人的年度患病率趋势以及治疗趋势。
设计、背景和参与者：在这项横断面研究中，使用医疗保险和医疗补助服务中心的可识别研究档案，从索赔数据中分析65岁及以上患者的数据。受益人在日历年连续参加医疗保险B部分的按服务收费（FFS）保险，并且在日历年或1年回顾期内有1次或更多次住院索赔或2次或更多次门诊索赔的糖尿病诊断。
使用诊断和程序代码，确定患有以下1项或更多项索赔的受益人的年度患病率：（1）任何DME；（2）DME或VTDR；（3）抗血管内皮生长因子（VEGF）注射、激光光凝或玻璃体切除术，按任何DME、伴有DME的VTDR和不伴有DME的VTDR分层。呈现2018年诊断和治疗方面的种族和民族差异。
2018年，6960823名受益人（27.4%）患有糖尿病；一半年龄在65至74岁（49.7%），一半（52.7%）为女性，75.7%为非西班牙裔白人。从2009年到2018年，有1项或更多项任何DME索赔（从1.0%增至3.3%）和DME/VTDR索赔（从2.8%增至4.3%）的糖尿病受益人的年度患病率有所上升。抗VEGF的年度患病率上升，特别是在患有任何DME（从15.7%增至35.2%）或伴有DME的VTDR（从20.2%增至47.6%）的患者中。在患有任何DME、伴有DME的VTDR和不伴有DME的VTDR的人群中，激光光凝的年度患病率下降（分别从45.5%降至12.5%、从54.0%降至20.3%、从22.5%降至5.8%）。在所有3组中，2018年玻璃体切除术的患病率不到2009年的一半。任何DME和DME/VTDR的患病率在西班牙裔受益人（分别为5.0%和7.0%）和黑人受益人（分别为4.5%和6.2%）中最高，在非西班牙裔白人受益人（分别为3.0%和3.8%）中最低。在患有DME/VTDR的人群中，抗VEGF在非西班牙裔白人受益人中最为普遍（30.3%）。
从2009年到2018年，医疗保险B部分FFS受益人中DME或VTDR的患病率上升，同时抗VEGF治疗增加，激光光凝和玻璃体切除术减少。
