A study published in Ophthalmology Science revealed an association between insurance status and diabetic retinopathy (DR).
Give me some background first.
Diabetic retinopathy (DR) is a leading cause of vision impairment around the world, with stages including proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME).
To note, a previous study demonstrated that health insurance status is strongly linked to risk of progression from non-proliferative diabetic retinopathy (NPDR) to PDR.
Now, talk about the study.
Using a retrospective cohort design, researchers used electronic health record (EHR) data from the University of California, San Francisco (UCSF) to determine the time between first NPDR diagnosis to first PDR diagnosis in a cohort of patients.
Who was included in the study?
A total of 716 participants met the following inclusion criteria:
- 18 years old and older
- Type 1 or 2 diabetes mellitus (DM)
Patients with a prior diagnosis of PDR were excluded from the study.
What did the cohort’s insurance status look like?
Participant insurance status at their baseline eyecare visit was identified as the following:
- 81% with Medicare or private insurance
- 15% with Medicaid
- 4% were uninsured
And the findings?
Patients without Medicare or private insurance presented with more advanced DR at baseline eye care visits than those with Medicare or insurance—perhaps due to lack of access to preventative care, the authors reasoned—which increased the risk of progression to PDR.
Expert opinion?
Based on the results, the study indicated that, “health insurance is an important risk factor for PDR progression, but having any insurance (i.e., Medicaid) is not enough to eliminate health disparities,” according to study authors.
Any limitations?
EHR data lacked information regarding prior eye exams and primary care visits, making it difficult for study authors to determine if the baseline NPDR visit is the same as the incidence visit.
Further, there was not enough power to determine an association between Medicaid and PDR progression. As all data was found from one institution, the sample may not accurately reflect the population and is limited in its generalizability.
Take home.
Insurance status has been demonstrated to be an important indicator of risk for DR progression, revealing information that could allow for more equitable access to eye care in the future.