title: Prevalence of diabetic retinopathy in the United States, 2005-2008.
abstract: BACKGROUND
  The prevalence of diabetes in the United States has increased. People with diabetes are at risk for diabetic retinopathy. No recent national population-based estimate of the prevalence and severity of diabetic retinopathy exists.
  
  
  OBJECTIVE
  To describe the prevalence and risk factors of diabetic retinopathy among US adults with diabetes aged 40 years and older.
  
  
  METHODS
  Analysis of a cross-sectional, nationally representative sample of the National Health and Nutrition Examination Survey 2005-2008 (N = 1006). Diabetes was defined as a self-report of a previous diagnosis of the disease (excluding gestational diabetes mellitus) or glycated hemoglobin A(1c) of 6.5% or greater. Two fundus photographs were taken of each eye with a digital nonmydriatic camera and were graded using the Airlie House classification scheme and the Early Treatment Diabetic Retinopathy Study severity scale. Prevalence estimates were weighted to represent the civilian, noninstitutionalized US population aged 40 years and older.
  
  
  METHODS
  Diabetic retinopathy and vision-threatening diabetic retinopathy.
  
  
  RESULTS
  The estimated prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was 28.5% (95% confidence interval [CI], 24.9%-32.5%) and 4.4% (95% CI, 3.5%-5.7%) among US adults with diabetes, respectively. Diabetic retinopathy was slightly more prevalent among men than women with diabetes (31.6%; 95% CI, 26.8%-36.8%; vs 25.7%; 95% CI, 21.7%-30.1%; P = .04). Non-Hispanic black individuals had a higher crude prevalence than non-Hispanic white individuals of diabetic retinopathy (38.8%; 95% CI, 31.9%-46.1%; vs 26.4%; 95% CI, 21.4%-32.2%; P = .01) and vision-threatening diabetic retinopathy (9.3%; 95% CI, 5.9%-14.4%; vs 3.2%; 95% CI, 2.0%-5.1%; P = .01). Male sex was independently associated with the presence of diabetic retinopathy (odds ratio [OR], 2.07; 95% CI, 1.39-3.10), as well as higher hemoglobin A(1c) level (OR, 1.45; 95% CI, 1.20-1.75), longer duration of diabetes (OR, 1.06 per year duration; 95% CI, 1.03-1.10), insulin use (OR, 3.23; 95% CI, 1.99-5.26), and higher systolic blood pressure (OR, 1.03 per mm Hg; 95% CI, 1.02-1.03).
  
  
  CONCLUSIONS
  In a nationally representative sample of US adults with diabetes aged 40 years and older, the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was high, especially among Non-Hispanic black individuals.
authors.affiliation: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA 30341-3727, USA. XZhang4@cdc.gov
authors.forename: Xinzhi
authors.initials: X
authors.lastname: Zhang
authors.forename: Jinan B
authors.initials: JB
authors.lastname: Saaddine
authors.forename: Chiu-Fang
authors.initials: CF
authors.lastname: Chou
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: Cotch
authors.forename: Yiling J
authors.initials: YJ
authors.lastname: Cheng
authors.forename: Linda S
authors.initials: LS
authors.lastname: Geiss
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
authors.forename: Ann L
authors.initials: AL
authors.lastname: Albright
authors.forename: Barbara E K
authors.initials: BE
authors.lastname: Klein
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014786:Vision Disorders / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology