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Participants were stratified by race\/ethnicity (White, Hispanic, Black, Asian, Other) and by DN and\/or DFU status. Propensity score matching (1:1) balanced baseline characteristics. The primary outcome was progression to TW-DED, defined as proliferative diabetic retinopathy, macular oedema, vitreous haemorrhage, or need for retinopathy-related treatment, assessed over 10 years. Risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) were reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 130,002 patients with NPDR, Hispanic (RR 1.40, 95% CI 1.32\u20131.48), Black (RR 1.15, 95% CI 1.10\u20131.20), and Other (RR 1.13, 95% CI 1.04\u20131.24) patients demonstrated higher risks of TW-DED progression than White patients. In multivariable analysis, race\/ethnicity was no longer significant, whereas DFU (HR 1.08, 95% CI 1.02\u20131.15) and DN (HR 1.06, 95% CI 1.01\u20131.12) remained independently associated with TW-DED. Stratified analysis revealed DFU consistently conferred greater risk than DN (Hispanic HR 1.39; Other HR 1.32; Black HR 1.27; White HR 1.22).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hispanic, Black, and Other groups had higher risk of TW-DED progression, but differences diminished after comorbidity adjustment. DFU and DN independently predicted progression, with DFU posing greater risk, suggesting microvascular disease burden and management differences may underlie racial differences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41433-026-04417-0","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T23:37:57Z","timestamp":1775518677000},"page":"1371-1377","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Racial and microvascular determinants of progression to treatment-warranted diabetic eye disease"],"prefix":"10.1038","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8689-6391","authenticated-orcid":false,"given":"Alexander T.","family":"Hong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan Y.","family":"Luu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tze-Woei","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian C.","family":"Toy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"4417_CR1","doi-asserted-by":"publisher","first-page":"556","DOI":"10.2337\/dc11-1909","volume":"35","author":"JW Yau","year":"2012","unstructured":"Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. 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