Differences in receipt of recommended eye examinations by comorbidity status and healthcare utilization among nonelderly adults with diabetes

BACKGROUND: To evaluate the effect of diabetes comorbidities by baseline healthcare utilization on receipt of recommended eye examinations. METHODS: Retrospective analysis of 310 691 nonelderly adults with type 2 diabetes in the IBM MarketScan Commercial Database from 2016 to 2019. Patients were grouped based on diabetes‐concordant (related) or ‐discordant (unrelated) comorbidities. Logistic regression was used to estimate the prevalence ratio (PR) for eye examinations by comorbidity status, healthcare utilization, and an interaction between comorbidities and utilization, controlling for age, sex, region, and major eye disease. RESULTS: Prevalence of biennial eye examinations varied by the four comorbidity groups: 43.5% (diabetes only), 52.7% (concordant + discordant comorbidities), 48.0% (concordant comorbidities only), and 45.3% (discordant comorbidities only). In the lowest healthcare utilization tertile, the concordant‐only and concordant + discordant groups had lower prevalence of examinations compared to diabetes only (PR 0.95 [95% CI 0.92–0.98] and PR 0.91 [95% CI 0.88–0.95], respectively). In the medium utilization tertile, the discordant‐only and concordant + discordant groups had lower prevalence of examinations (PR 0.89 [0.83–0.95] and PR 0.94 [0.90–0.98], respectively). In the highest utilization tertile, the concordant‐only and concordant + discordant groups had higher prevalence of examinations. CONCLUSIONS: Among patients with low healthcare utilization, having comorbid conditions is associated with lower prevalence of eye examinations. Among those with medium healthcare utilization, patients with diabetes‐discordant comorbidities are particularly vulnerable. This study highlights populations of diabetes patients who would benefit from increased assistance in receiving vision‐preserving eye examinations.