O'Neill Katherine Guerra, Buscho Seth E, Elmir Digbeu Biai Dominique, Dezeeuw Zachary, Merkley Kevin H, Gupta Praveena K
John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA.
Clin Ophthalmol. 2025 May 17;19:1609-1616. doi: 10.2147/OPTH.S519979. eCollection 2025.
Previous research has shown that racial disparities exist regarding the prevalence of and associated vision loss from diabetic retinopathy. Unfortunately, little is known about potential racial and ethnic disparities of diabetic eye exam referral patterns by primary care providers. Understanding referral patterns to ophthalmic specialists is key to understanding the steps needed to prevent progression of this vision-threatening condition, particularly in minority populations.
Patients who were diagnosed with type II diabetes mellitus (DM) at a tertiary medical center between 2015 and 2023 were retrospectively identified from the electronic medical record (n = 10,995). Patient demographics, comorbidities, presence or absence of ophthalmology referral, HbA1c and insulin dependence at time of referral, time from referral to first ophthalmic appointment, as well as diabetic retinopathy presence/stage at first ophthalmic exam after referral were collected.
Of the white patients who were diagnosed with DM, 79.3% were referred for ophthalmology screening, compared to 78.55% of Hispanic patients (RR: 1.03 [95% CI: 0.92, 1.15]) and 75.75% of black patients (RR: 0.83 [95% CI: 0.74, 0.93]) (p = 0.0009). 56.38% of White patients had a HbA1c ≥ 7% at referral compared to 61.33% of Hispanic patients (RR: 1.16 [95% CI: 1.00, 1.34]) and 53.48% of Black patients (RR 0.86 [95% CI: 0.73, 1.01]) (p = 0.0004). 5.69% of referred white patients were diagnosed with diabetic retinopathy compared to 10.22% of Black patients (RR: 1.88 [95% CI 1.58, 2.23) and 10.91% of Hispanic patients (RR: 1.58 [95% CI 1.32, 1.89]) (p < 0.0001).
Black patients were less likely to receive an ophthalmology referral at the time of DM diagnosis, and Hispanic patients were more likely to be referred at a more severe HbA1c compared to white patients. Both black and Hispanic patients were more likely to be diagnosed with diabetic retinopathy at first ophthalmic appointment than white patients.
先前的研究表明，糖尿病视网膜病变的患病率及相关视力丧失存在种族差异。遗憾的是，对于初级保健提供者进行糖尿病眼部检查转诊模式的潜在种族和民族差异知之甚少。了解眼科专家的转诊模式是理解预防这种视力威胁性疾病进展所需步骤的关键，尤其是在少数族裔人群中。
从电子病历中回顾性识别出2015年至2023年在一家三级医疗中心被诊断为II型糖尿病（DM）的患者（n = 10995）。收集患者的人口统计学信息、合并症、是否有眼科转诊、转诊时的糖化血红蛋白（HbA1c）和胰岛素依赖情况、从转诊到首次眼科就诊的时间，以及转诊后首次眼科检查时糖尿病视网膜病变的存在情况/阶段。
在被诊断为DM的白人患者中，79.3%被转诊进行眼科筛查，相比之下，西班牙裔患者为78.55%（相对风险：1.03 [95%置信区间：0.92, 1.15]），黑人患者为75.75%（相对风险：0.83 [95%置信区间：0.74, 0.93]）（p = 0.0009）。56.38%的白人患者在转诊时糖化血红蛋白≥7%，相比之下，西班牙裔患者为61.33%（相对风险：1.16 [95%置信区间：1.00, 1.34]），黑人患者为53.48%（相对风险0.86 [95%置信区间：0.73, 1.01]）（p = 0.0004）。5.69%的转诊白人患者被诊断患有糖尿病视网膜病变，相比之下，黑人患者为10.22%（相对风险：1.88 [95%置信区间1.58, 2.23]），西班牙裔患者为10.91%（相对风险：1.58 [95%置信区间1.32, 1.89]）（p < 0.0001）。
黑人患者在DM诊断时接受眼科转诊的可能性较小，与白人患者相比，西班牙裔患者在糖化血红蛋白水平更高时更有可能被转诊。黑人和西班牙裔患者在首次眼科就诊时被诊断患有糖尿病视网膜病变的可能性均高于白人患者。
