Retinopathy of prematurity: Does race matter?

Abstract

Objective: Severe Retinopathy of Prematurity (ROP) is a primary cause of visual morbidity for very low birth weight infants. Known risk factors include short gestational age, low birth weight and supplemental oxygen exposure. Some studies have shown that Black infants are less at risk for severe ROP than White infants, however this finding has not been confirmed in studies designed to look at the risk of ROP and race/ethnicity specifically. The purpose of this study is to assess the relationship between the race/ethnicity of infants and the risk of severe ROP for a sample of 1,604 infants in 1,189 hospitals located in 39 states. Patients and methods: ParadigmHealth database records for surviving infants born between 1/1/2001 and 12/31/2004 with a birth weight less than or equal to 1250 g were included in this analysis (n = 1,604). Multivariate logistic regression was used to assess the association between race/ethnicity and risk for severe ROP. Models were adjusted for birth weight, gestational age, Apgar score, race and measures of illness severity including days on oxygen and mechanical ventilation, sepsis, intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis and pneumothorax. Results: In the analytic data set, the distribution of maternal race was 47.2% White, 35.3% Black, 14.9% Hispanic and 3.2% Asian. Of these infants, 9.4% developed severe ROP; 6.6% for Blacks, 9.6% for Whites, 13.8% for Hispanics and 15.7% Asians. Compared to Black neonates, the unadjusted odds ratio for ROP among White infants was 1.5 (95% CI: 1.0, 2.3), for Hispanics 2.2 (95% CI: 1.4, 3.7) and for Asians 2.6 (95% CI: 1.2, 5.9). After adjustment for gestational age, birth weight and 1 minute Apgar score, the odds ratios increased to 2.0 (CI: 1.2, 3.2) for Whites, 2.7 (CI: 1.5, 4.8) for Hispanics and 5.3 (CI 1.9, 15.1) for Asians compared to Black neonates. Adjusting for additional markers of illness severity did not alter these results. Conclusions: Results revealed lower rates of ROP among Black confirming findings from earlier studies. Interestingly, relatively high rates of ROP were also found among Hispanic and Asian neonates compared to Black infants. Controlling for possibly confounding morbidities and measures of illness severity did not alter these results. Further research in this area is warranted.