Association between insurance status and prevalence of diabetic retinopathy in patients with diabetes in the United States from 2011 to 2020

Aim: To determine whether an association exists between health insurance and diabetic retinopathy (DR) prevalence in adults with diabetes. Methods: An analytical cross-sectional study was conducted utilizing the National Health and Nutrition Examination Survey database. 4530 Patients aged >= 18 with diabetes from 2011 to 2020 with various insurance types (no insurance, private, Medicare, Medicaid, or other) were evaluated for prevalence of DR, including covariates. Unadjusted and adjusted logistic regression analysis were conducted to calculate odds ratios (OR) and 95 % confidence intervals (CI). Results: There was no significant association between insurance status and DR prevalence when adjusting for confounders. OR for DR in patients without insurance, Medicare, Medicaid, or other insurance compared to those with private insurance were 1.13 (95 % CI 0.74-1.71), 0.78 (95 % CI 0.54-1.13), 1.20 (95 % CI 0.80-1.81), and 0.81 (95 % CI 0.47-1.37) respectively. However, factors like age >= 65 and use of diabetes medication were associated with reduced DR prevalence. Conclusion: Although insurance status alone does not have an association with the prevalence of DR, this study highlights several confounding variables that potentially influence previously reported associations between insurance status and DR.