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The characteristics of racial disparity in retinopathy of prematurity outcomes

Journal of Perinatology (2025)Cite this article

Subjects

Abstract

Objective

To characterize racial disparities in retinopathy of prematurity (ROP) requiring treatment and to investigate specific treatment patterns across racial groups.

Study design

Retrospective analysis of de-identified data from ROP Check®, a cloud-based electronic medical record system for neonatology screening and ophthalmology tracking ROP examinations and treatment. Data from 28 hospitals from 2011 to 2022 included 3631 surviving premature infants with recorded race.

Results

American Indian/Alaska Native (AI/AN), Asian, and Pacific Islander (PI) infants had the highest rates of ROP treatment at both early (21–25 weeks) and later gestational ages (26–30 weeks) while African American infants had the lowest and most pronounced at later gestational ages (26–30 weeks). AI/AN infants had earlier and more multiple treatments.

Conclusions

Our study identifies PI race, alongside AI/AN and Asian backgrounds, as high-risk categories for treatment-warranted ROP. The inclusion of race to gestational age and birthweight enhances the prediction of treatment-warranted ROP.

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Data availability

https://www.abcd-vision.org/references/ROPrace2025.pdf.

References

  1. Wallace ME, Mendola P, Kim SS, Epps N, Chen Z, Smarr M, et al. Racial/ethnic differences in preterm perinatal outcomes. Am J Obstet Gynecol. 2017;216:306.e1–306.e12.

    Article  PubMed  Google Scholar 

  2. Janevic T, Zeitlin J, Auger N, Egorova NN, Hebert P, Balbierz A, et al. Association of race/ethnicity with very preterm neonatal morbidities. JAMA Pediatr. 2018;172:1061–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ying GS, Bell EF, Donohue P, Tomlinson LA, Binenbaum G, G-ROP Research Group. Perinatal risk factors for the retinopathy of prematurity in postnatal growth and Rop Study. Ophthal Epidemiol. 2019;26:270–8.

    Article  Google Scholar 

  4. Yang MB, Donovan EF, Wagge JR. Race, gender, and clinical risk index for babies (CRIB) score as predictors of severe retinopathy of prematurity. J AAPOS. 2006;10:253–61.

    Article  PubMed  Google Scholar 

  5. Cheng QE, Daniel E, Pan W, Baumritter A, Quinn GE, Ying GS, et al. Plus disease in telemedicine approaches to evaluating acute-phase ROP (e-ROP) study: characteristics, predictors, and accuracy of image grading. Ophthalmology. 2019;126:868–75.

    Article  PubMed  Google Scholar 

  6. Tadesse M, Dhanireddy R, Mittal M, Higgins RD. Race, Candida sepsis, and retinopathy of prematurity. Biol Neonate. 2002;81:86–90.

    Article  PubMed  Google Scholar 

  7. Wang J, Ying GS, Yu Y, Tomlinson L, Binenbaum G. Racial differences in retinopathy of prematurity. Ophthalmic Epidemiol. 2023;30:523–31.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Karmouta R, Altendahl M, Romero T, Piersante T, Langston S, Khitri M, et al. Association between social determinants of health and retinopathy of prematurity outcomes. JAMA Ophthalmol. 2022;140:496–502.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lang DM, Blackledge J, Arnold RW. Is Pacific race a retinopathy of prematurity risk factor? Arch Pediatr Adolesc Med. 2005;159:771–3.

    Article  PubMed  Google Scholar 

  10. Arnold RW, Kesler K, Avila E. Susceptibility to retinopathy of prematurity in Alaskan Natives. J Pediatr Ophthalmol Strabismus. 1994;31:192–4.

    Article  CAS  PubMed  Google Scholar 

  11. Fierson WM.American Academy oF PEDIATRICS Section on Ophthalmology. et al. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2018;142:1–9.

    Article  Google Scholar 

  12. Arnold RW, Jacob J, Matrix Z. Toward achieving 100% adherence for retinopathy of prematurity screening guidelines. J Pediatr Ophthalmol Strabismus. 2017;54:356–62.

    Article  PubMed  Google Scholar 

  13. Brown DR, Biglan AW, Stretavsky MM. Retinopathy of prematurity: the relationship with intraventricular hemorrhage and bronchopulmonary dysplasia. J Pediatr Ophthalmol Strabismus. 1990;27:268–71.

    Article  CAS  PubMed  Google Scholar 

  14. Glaser K, Härtel C, Klingenberg C, Herting E, Fortmann MI, Speer CP, et al. Neonatal sepsis episodes and retinopathy of prematurity in very preterm infants. JAMA Netw Open. 2024;7:e2423933.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Fundora JB, Binenbaum G, Tomlinson L, Yu Y, Ying GS, Maheshwari A, et al. Association of surgical necrotizing enterocolitis and its timing with retinopathy of prematurity. Am J Perinatol. 2023;40:1178–84.

    Article  PubMed  Google Scholar 

  16. Arnaiz-Villena A, Parga-Lozano C, Moreno E, Areces C, Rey D, Gomez-Prieto P. The origin of Amerindians and the peopling of the Americas according to HLA genes: admixture with Asian and Pacific people. Curr Genom. 2010;11:103–14.

    Article  CAS  Google Scholar 

  17. Anderson KG, Spicer P, Peercy MT. Obesity, diabetes, and birth outcomes among American Indians and Alaska Natives. Matern Child Health J. 2016;20:2548–56.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Yuan J, Gu X, Yang J, Lin X, Hu J, Jiang S, et al. Impact of maternal diabetes mellitus on neonatal outcomes among infants <32 weeks of gestation in China: a multicenter cohort study. Am J Perinatol. 2024;41:e2474–84.

  19. Persson M, Shah PS, Rusconi F, Reichman B, Modi N, Kusuda S, et al. Association of maternal diabetes with neonatal outcomes of very preterm and very low-birth-weight infants: an international cohort study. JAMA Pediatr. 2018;172:867–75.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Opara CN, Akintorin M, Byrd A, Cirignani N, Akintorin S, Soyemi K. Maternal diabetes mellitus as an independent risk factor for clinically significant retinopathy of prematurity severity in neonates less than 1500g. PLoS ONE. 2020;15:e0236639.

  21. Boghossian NS, Geraci M, Edwards EM, Horbar JD. In-hospital outcomes in large for gestational age infants at 22-29 weeks of gestation. J Pediatr. 2018;198:174–80.

    Article  PubMed  Google Scholar 

  22. Gimenez LG, Gili JA, Elias DE, Sagula R, Comas B, Santos MR, et al. Genetic susceptibility for retinopathy of prematurity and its associated comorbidities. Pediatr Res. 2024;96:1325–31.

    Article  CAS  PubMed  Google Scholar 

  23. Mohamed S, Schaa K, Cooper ME, Ahrens E, Alvarado A, Colaizy T, et al. Genetic contributions to the development of retinopathy of prematurity. Pediatr Res. 2009;65:193–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Paradis H, Werdyani S, Gendron RL, Gendron RL, Tabrizchi R, McGovern M, et al. Genetic variants of the beta-adrenergic receptor pathways as both risk and protective factors for retinopathy of prematurity. Am J Ophthalmol. 2024;263:179–87.

    Article  CAS  PubMed  Google Scholar 

  25. Li X, Owen LA, Taylor KD, Ostmo S, Chen YI, Coyner AS, et al. Genome-wide association identifies novel ROP risk loci in a multi-ethnic cohort. Commun Biol. 2024;7:107.

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Author information

Authors and Affiliations

  1. Neonatology (retired), Alaska Neonatology Associates, Anchorage, AK, USA

    Jack Jacob

  2. Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA

    Robert W. Arnold

Authors
  1. Jack Jacob
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  2. Robert W. Arnold
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Contributions

Jack Jacob designed the work, collected data, drafted the manuscript, approves and agrees to be accountable for this work. Robert Arnold analyzed the data, critically reviewed the manuscript, and approves and agrees to be accountable for this work.

Corresponding author

Correspondence to Robert W. Arnold.

Ethics declarations

Competing interests

JJ and RA developed ROP Check® software but no longer own it. They both serve as consultants for NeoLight.

Ethics approval and consent to participate

This study complies with the Declaration of Helsinki and HIPAA. IRB exemption (45 CFR § 46.104(d)(4),) was obtained for using the de-identified data set from WCG IRB on 3/4/24. Parental written consent was waived.

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Jacob, J., Arnold, R.W. The characteristics of racial disparity in retinopathy of prematurity outcomes. J Perinatol (2025). https://doi.org/10.1038/s41372-025-02355-5

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