Trends in Prevalence and Incidence of Diabetic Retinal Disease Across Age Cohorts

Two recent studies have suggested that younger diabetes mellitus (DM) patients are progressing to DRD at higher rates than in previous years. This study aims 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 across age groups over time. Retrospective cohort study comprised of members of commercial and Medicare Advantage health plans between 2000 and 2022 Cohorts of patients aged ≤25, 26-45, 46-64, and age ≥65 were created from all patients with DM identified using ICD-9/-10 codes. Logistic and Poisson regression models were used to estimate prevalence and incidence, respectively. The main outcomes were the unadjusted prevalence and incidence of DRD, VTDR, DME, and PDR. Age cohorts remained proportional with respect to DRD prevalence(P) and incidence(I) over the 20 years analyzed. The ≤25 age cohort was always the lowest, followed by the 26-45, 46-64, and ≤65 cohorts, respectively (2001-2021 ≤25 P=3.0-4.5%, I=5.1-11.1cases/1000 person years; 26-45 P=6.3-10.9%, I=9.7-21.0; 46-64 P=10.6-15.7% I=14.7-30.9, ≥65 P=13.2-23.1%, I=20.0-39.2). Similar proportional relationships were seen for VTDR and DME prevalence. However, VTDR and DME incidence saw differences with ≥65 age cohort (2022 VTDR I=6.0 cases/1000 py; DME I=5.0), ending lower than the 44-64 age cohort (2022 VTDR I=7.1, DME=5.5) while the 26-45 (2022 VTDR I=4.7, DME I=3.2) and ≤25 (2022 VTDR I=2.0 DME I=1.7) were the next lowest, respectively (p<0.001 for all comparisons across age in 2022). PDR prevalence was highest in the≥65 cohort (3.7%) until 2021, when it became similar to the 46-64 age cohort (3.5%) (p=0.40). PDR incidence also declined significantly in ≥65 cohort (2022 I=2.3) ending lower than 46-64 cohort (I=3.8) and similar to the 26-44 cohort (I=2.6), but still higher than the ≤25 cohort (I=0.6)(p=0.007for ≥65v≤25 and p<0.001 for ≥65v46-64, p=0.07 for ≥65v26-45). In contrast to recent studies, no evidence was found to suggest DRD is progressing faster in those ≤25. Those ≥65 saw significant declines in DRD prevalence and incidence over the observation period.