OBJECTIVE To evaluate the association between initial diabetic retinopathy (DR) severity/risk of blindness in patients with newly diagnosed DR/good vision in the U.S. RESEARCH DESIGN AND METHODS This retrospective cohort study evaluated adult patients with good vision (20/40 or better) and newly diagnosed DR between 1 January 2013 and 31 December 2017 (index date) in the American Academy of Ophthalmology’s Intelligent Research in Sight (IRIS) Registry. The primary exposure of interest was DR severity at index: mild nonproliferative DR (NPDR), moderate NPDR, severe NPDR, and proliferative DR (PDR). The main outcome measure was development of sustained blindness (SB), defined as study eyes with Snellen visual acuity readings of 20/200 or worse at two separate visits ≥3 months apart that did not improve beyond 20/100. RESULTS Among 53,535 eligible eyes (mean follow-up 662.5 days), 678 (1.3%) eyes developed SB. Eyes with PDR at index represented 10.5% (5,629 of 53,535) of the analysis population but made up 26.5% (180 of 678) of eyes that developed SB. Kaplan-Meier analysis revealed that eyes with moderate NPDR, severe NPDR, and PDR at index were 2.6, 3.6, and 4.0 times more likely, respectively, to develop SB after 2 years of DR diagnosis versus eyes with mild DR at index. In a Cox proportional hazards model adjusted for index characteristics/development of ocular conditions during follow-up, eyes with PDR had an increased risk of developing SB versus eyes with mild NPDR at index (hazard ratio 2.26 [95% CI 2.09−2.45]). CONCLUSIONS In this longitudinal ophthalmologic registry population involving eyes with good vision, more advanced DR at first diagnosis was a significant risk factor for developing SB.

Targeted outreach and education in communities should be informed by these research findings with an eye toward promoting the economic, education, and health benefits of enrolling in DACA. Social policies that address the social determinants of health have significant potential to address health inequities.

a b s t r a c tThere are currently 1.5 million undocumented Asians and Pacific Islanders (APIs) in the US. Undocumented API young adults, in particular, come of age in a challenging political and social climate, but little is known about their health outcomes. To our knowledge, this is the first study to assess the psychosocial needs and health status of API undocumented young adults. Guided by social capital theory, this qualitative study describes the social context of API undocumented young adults (ages 18e31), including community and government perceptions, and how social relationships influence health. This study was conducted in Northern California and included four focus group discussions (FGDs) and 24 in-depth interviews (IDIs), with 32 unique participants total. FGDs used purposeful sampling by gender (two male and two female discussions) and education status (in school and out-of-school). Findings suggest low bonding and bridging social capital. Results indicate that community distrust is high, even within the API community, due to high levels of exploitation, discrimination, and threats of deportation. Participants described how documentation status is a barrier in accessing health services, particularly mental health and sexual and reproductive health services. This study identifies trusted community groups and discusses recommendations for future research, programs, and policies.

Purpose Low educational attainment has been associated with depression among Latinos. However, few studies have collected intergenerational data to assess mental health effects of educational mobility across generations. Methods Using data from the Niños Lifestyle and Diabetes Study, we assessed the influence of intergenerational education on depressive symptoms among 603 Mexican-origin individuals. Intergenerational educational mobility was classified: stable-low (low parent/low offspring education), upwardly-mobile (low parent/high offspring education), stable-high (high parent/high offspring education), or downwardly-mobile (high parent/low offspring education). High depressive symptoms were defined as scoring ≥10 on the CESD-10. We examined prevalence ratios (PR) for depressive symptoms with levels of educational mobility. We used general estimating equations with log-binomial models to account for within-family clustering, adjusting for age, sex, and offspring and parent nativity. Results Compared to stable-low participants, the lowest prevalence of CESD-10 score ≥10 occurred in upwardly-mobile (PR=0.55; 95% confidence interval [CI]=0.39–0.78) and stable-high (PR=0.62; 95%CI=0.44–0.87) participants. Downwardly-mobile participants were also less likely to have a CESD-10 score ≥10 compared to stable-low participants (PR=0.65; 95%CI=0.38–1.11), although the estimate was not statistically significant. Conclusions Sustained stress from low intergenerational education may adversely affect depression. Latinos with stable-low or downwardly-mobile intergenerational educational attainment may need closer monitoring for depressive symptoms.

Background Type 2 diabetes has been associated with higher levels of depression and depressive symptoms. Few longitudinal studies have been conducted of comorbid depression and diabetes, especially among Latinos. Objectives To determine whether diabetes increased the progression to elevated depressive symptoms among older Latinos in a population-based cohort. Design Prospective cohort study. Participants Individuals from the Sacramento Latino Study on Aging, aged ≥60 years in 1998–1999 and followed annually until 2008 (n=1586). Main Measures We defined diabetes by self-report, fasting blood glucose ≥126 mg/dL or HbA1c ≥6.5%, diabetic medication use. Elevated depressive symptoms were defined as Center for Epidemiological Studies-Depression (CES-D) score ≥16, or use of antidepressant medication. Multi-state Markov modeling was used to assess the effects of time-dependent diabetes on transitions between 3 states over time: 1) low CES-D score (“Normal”), 2) elevated CES-D score/Treated (“Depressed”), and 3) Death. Bivariate analyses identified covariates significantly associated with any transition. These included gender and baseline measures of age, education, body mass index, hypertension, and stroke. Results In a fully adjusted model, compared to non-diabetics, diabetics had a 35% higher rate of developing elevated depressive symptoms or starting treatment with an antidepressant (HR 1.35, 95% CI 1.13, 1.62). Time-dependent diabetes was associated with a lower rate of regression from Depressed to Normal (HR 0.72, 95% CI 0.59, 0.88) and 2.3 fold increase in progression from a Depressed state to Death (HR 2.31, 95% CI 1.57, 3.40). Conclusion Diabetes increased the risk of developing elevated depressive symptoms among older Mexican-Americans. Older Latinos with diabetes should be screened for depressive symptoms and prioritized for closer follow-up, potentially through increased reliance on team-based models of care.