A 10-year trend in the incidence of retinopathy of prematurity in Sichuan, China

Objective To analyze the 10-year incidence trend of retinopathy of prematurity (ROP) in Sichuan, China, and explore associated clinical factors and screening strategies. Methods In this single-center retrospective study, 603 premature infants undergoing ROP screening between 2014 and 2023 were included. Incidence rates were calculated across five biennial periods, stratified by birth weight and gestational age. Cochran-Armitage test assessed trends; a decision model evaluated screening thresholds; correlation/regression analyses identified clinical associations. Results Overall ROP incidence was 19.2% (116/603); Type 1 ROP incidence was 5.1% (31/603). ROP incidence declined from 22.8% to 16.5%, and Type 1 ROP from 5.9% to 4.2% over the study period. No Type 1 ROP occurred in infants 1,500 g or 32 weeks after 2018, with a statistically significant downward trend ( P 0.05). Sepsis/bacteremia incidence positively correlated with ROP (r = 0.83, P 0.01), while oxygen therapy compliance (r = −0.89, P 0.01) and breastfeeding (r = −0.76, P 0.05) showed negative correlations. Sepsis/bacteremia was an independent risk factor ( β =0.45, P 0.01). Adjusting the screening threshold to 1,500 g maintained a Type 1 ROP detection rate of 96.8% while reducing screening costs by 32.5% and false positives by 28.3%. Conclusion ROP incidence in Sichuan declined significantly over the past decade. Sepsis is a key risk factor, while improved oxygen therapy and breastfeeding are protective. Adjusting the screening threshold to 1,500 g may enhance screening cost-effectiveness for tertiary medical centers in Sichuan while maintaining a high detection rate for severe ROP.