糖尿病视网膜病变患病率和发病率的20年趋势
Twenty-Year Trends in Prevalence and Incidence of Diabetic Retinal Disease.
作者信息
VanderBeek Brian L, Yu Yinxi, Cardillo Serena, Hubbard Rebecca
机构信息
Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Research and Training in Pharmacoepidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
Ophthalmology. 2025 Jul;132(7):767-774. doi: 10.1016/j.ophtha.2025.01.022. Epub 2025 Jan 30.
PURPOSE
To determine how the rates of diabetic retinal disease (DRD) and its vision-threatening components (VTDR), diabetic macular edema (DME), and proliferative diabetic retinopathy (PDR) among patients with diabetes mellitus (DM) have changed over the past 20 years.
DESIGN
Retrospective cohort study.
PARTICIPANTS
All DM patients insured by commercial and Medicare Advantage insurance plans in a claims database from 2000 through 2022 and at least 1 full calendar year of data. Cohorts were created using International Classification of Diseases codes to determine the yearly prevalence and incidence of DRD, VTDR, DME, and PDR.
METHODS
Logistic and Poisson regression models created prevalence and incidence estimates, respectively.
MAIN OUTCOME MEASURES
DRD, DME, and PDR prevalence and incidence.
RESULTS
The prevalence of DRD initially decreased from 2001 (13.6%) to 2007 (10.9%), but then increased every year through 2021 (20.8%; P < 0.001, adjusted test for trend [aTT]). Incidence of DRD varied considerably, ranging from 16.9 cases per 1000 patient-years in 2013 to its highest of 32.2 cases per 1000 patient-years in 2021 (P < 0.001, aTT). The prevalence of VTDR and DME trended similarly, with increases from 2007 (VTDR, 5.2%; DME, 3.2%) through 2016 (VTDR, 7.5%; DME, 5.4%), followed by decreases each year through 2021 (VTDR, 6.9%; DME, 4.9%; P < 0.001, aTT). The VTDR and DME incidence rates peaked in 2009 (VTDR, 12.4 cases per 1000 patient-years; DME, 8.6 cases per 1000 patient-years) and decreased through 2022 (VTDR, 6.1 cases per 1000 patient-years; DME, 5.0 cases per 1000 patient-years; P < 0.001, aTT, for both VTDR and DME). Prevalence of PDR varied between 3.2% and 4.0% throughout the 20-year observation period (P < 0.001, aTT). Incidence of PDR decreased over time to 2.6 cases per 1000 patient-years in 2022 (P < 0.001, aTT).
CONCLUSIONS
DRD prevalence (through 2007) and incidence (through 2014) initially decreased, but the rate of each has doubled since. Despite increases in DRD, incidence rates of VTDR, DME, and PDR have improved dramatically over the past 20 years.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的
确定过去20年中糖尿病患者糖尿病视网膜病变（DRD）及其致盲性病变（VTDR）、糖尿病性黄斑水肿（DME）和增殖性糖尿病视网膜病变（PDR）的发病率变化情况。
设计
回顾性队列研究。
参与者
2000年至2022年期间，商业保险和医疗保险优势保险计划承保的所有糖尿病患者，且至少有一整年的数据。使用国际疾病分类代码创建队列，以确定DRD、VTDR、DME和PDR的年度患病率和发病率。
方法
逻辑回归模型和泊松回归模型分别用于估计患病率和发病率。
主要观察指标
DRD、DME和PDR的患病率和发病率。
结果
DRD患病率最初从2001年的13.6%降至2007年的10.9%，但随后逐年上升，至2021年达到20.8%（P<0.001，趋势调整检验[aTT]）。DRD发病率差异很大，从2013年的每1000患者年16.9例到2021年的最高值每1000患者年32.2例（P<0.001，aTT）。VTDR和DME的患病率趋势相似，从2007年（VTDR为5.2%；DME为3.2%）至2016年（VTDR为7.5%；DME为5.4%）上升，随后逐年下降，至2021年（VTDR为6.9%；DME为4.9%；P<0.001，aTT）。VTDR和DME发病率在2009年达到峰值（VTDR为每1000患者年12.4例；DME为每1000患者年8.病例），并在2022年下降（VTDR为每1000患者年6.1例；DME为每1000患者年5.0例；VTDR和DME的P<0.001，aTT）。在整个20年观察期内，PDR患病率在3.2%至4.0%之间变化（P<0.001，aTT）。PDR发病率随时间下降，至2022年降至每1000患者年2.6例（P<0.001，aTT）。
结论
DRD患病率（至2007年）和发病率（至2014年）最初下降，但此后两者均翻倍。尽管DRD有所增加，但在过去20年中，VTDR、DME和PDR的发病率显著改善。
财务披露
本文末尾的脚注和披露中可能会有专有或商业披露。
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