Findings from University of California Advance Knowledge in Diabetic Retinopathy (The Relationship Between Health Insurance Status and Diabetic Retinopathy Progression): Nutritional and Metabolic Diseases and Conditions – Diabetic Retinopathy

2024 MAY 02 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Data detailed on diabetic retinopathy have been presented. According to news reporting originating from San Francisco, California, by NewsRx correspondents, research stated, “To determine if baseline diabetic retinopathy (DR) severity mediates the relationship between health insurance status and DR progression. Retrospective cohort study.”

The news editors obtained a quote from the research from University of California: “Subjects: Seven hundred sixteen patients aged 18 years with a diagnosis of type 1 or 2 diabetes mellitus, and a diagnosis of nonproliferative DR (NPDR) were identified from the electronic health record of a tertiary academic center between June 2012 and February 2022. NPDR severity at baseline was the proposed mediator in the relationship between insurance status and proliferative DR (PDR) progression. Logistic regression was used to determine the association between insurance status and NPDR severity at baseline, and Cox proportional hazards regression was used to assess the association between insurance status and time to PDR progression. To analyze the mediation effect of NPDR severity at baseline, a counterfactual approach, which decomposes a total effect into a natural direct effect and a natural indirect effect was applied. Main Outcome Measures: Time to progression from first NPDR diagnosis to first PDR diagnosis. Of the 716 patients, 581 (81%) had Medicare or private insurance, 107 (15%) had Medicaid, and 28 (4.0%) were uninsured at their baseline eye visit. Uninsured or Medicaid patients had a higher proportion of moderate or severe NPDR at their baseline eye visit and a higher proportion of progression to PDR. After adjusting for confounders and NPDR severity at baseline, patients who were uninsured had significantly greater risk of progression to PDR compared with that of patients with Medicare/private insurance (hazard ratio [HR]: 2.63; 95% confidence interval [CI]: 1.10-6.25). Patients with Medicaid also had an increased risk of progression to PDR compared with that of patients with Medicare/private insurance, although not statistically significant (HR: 1.53; 95% CI: 0.81-2.89). NPDR severity at baseline mediated 41% of the effect of insurance status (uninsured vs. Medicare/private insurance) on PDR progression.”

According to the news editors, the research concluded: “Patients who were uninsured were more likely to have an advanced stage of NPDR at their baseline eye visit and were at significantly greater risk of progression to PDR compared with patients who had Medicare or were privately insured. Mediation analysis revealed that differences in baseline NPDR severity by insurance explained a significant proportion of the relationship between insurance status and DR progression. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.”

For more information on this research see: The Relationship Between Health Insurance Status and Diabetic Retinopathy Progression. Ophthalmology Science, 2024,4(3):100458. The publisher for Ophthalmology Science is Elsevier.

A free version of this journal article is available at https://doi.org/10.1016/j.xops.2023.100458.

Our news journalists report that additional information may be obtained by contacting MS Yian Guo, Department of Ophthalmology, University of California, San Francisco, California, United States. Additional authors for this research include MPH Ivan A. Copado, MPH Sean Yonamine, MD PhD Chu Jian Ma, MD Stephen McLeod, PhD Benjamin F. Arnold, PhD Charles E. McCulloch, MD Catherine Q. Sun.

(Our reports deliver fact-based news of research and discoveries from around the world.)