Cindy X. Cai, MD: Impact of Race, Neighborhood on Diabetic Retinopathy Care

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Cindy X. Cai, MD, describes how both place and individual-level factors are associated with lapses in diabetic retinopathy care.

Race and neighborhood play a notable role in facilitating lapses in diabetic retinopathy care, according to a recent analysis published in JAMA Ophthalmology.

Areas with socioeconomic disadvantages demonstrated a greater likelihood for lapses in diabetic retinopathy care, compared with less disadvantaged neighborhoods. Non-Hispanic White patients from these deprived neighborhoods were more likely to experience lapses in their care, compared with those less disadvantaged.

Meanwhile, non-Hispanic Black and Hispanic patients from almost all examined neighborhoods experienced a greater risk of lapses in care, compared with non-Hispanic White patients from the least disadvantaged areas.

In an interview with HCPLive, investigator Cindy X. Cai, MD, Wilmer Eye Institute, Johns Hopkins University School of Medicine, described the importance of researching vision outcomes among diabetic patients through the lens of health equity, particularly the interplay between community deprivation and the impact by race and ethnicity categories.

“Certainly, for diabetic retinopathy care, there is more that we can do. We know that when patients don’t follow up with us, that’s what they develop vision-threatening diseases,” Cai told HCPLive. “As clinicians, being mindful that some communities need more help than others in returning for care, and how we think about changes we can institute within our clinicians, is critical.”

Adults with diabetes were observed at the Wilmer Eye Institute from 2013 to 2022 for diabetic retinopathy screening or treatment, to analyze lapses in diabetic retinopathy care over 2 years. The primary exposures were the patient neighborhood socioeconomic disadvantage quantified using the 2019 area deprivation index (ADI).

Across more than 36,000 patients, more than half (63%) experienced lapses in care, including 60% in ADI Q1 (lowest disadvantage) and 68% in Q4 (highest disadvantage). An interaction was observed between ADI and race and ethnicity (P = .005).

According to the pairwise comparisons, non-Hispanic Black, and Hispanic patients from higher ADI quartiles demonstrated more risk of lapses in care, compared with non-Hispanic White patients in Q1 and Q2.

“More research is definitely needed to understand why we’re seeing these different patterns, I think that will give us highlights and insights into what policy changes can impact health outcomes,” Cai told HCPLive.

For more insight into the analysis, watch the full interview with Cai.


Iapoce C. Race, neighborhood influence lapses in diabetic retinopathy care. HCP Live. April 26, 2024. Accessed June 3, 2024.

Tang T, Tran D, Han D, Zeger SL, Crews DC, Cai CX. Place, Race, and Lapses in Diabetic Retinopathy Care. JAMA Ophthalmol. Published online April 25, 2024. doi:10.1001/jamaophthalmol.2024.0974