Effect of Socioeconomic Status on Hyperglycemia and Retinopathy Levels in Mexican Americans With NIDDM

Haffner, Steven M.; Hazuda, Helen P.; Stern, Michael P.; Patterson, Judith K.; Heuven, W. A. J. Van; Fong, Donald S.

doi:10.2337/diacare.12.2.128

Cited by 73 publications

(39 citation statements)

References 10 publications

(19 reference statements)

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“…Socioeconomic status does not appear to be an important determinant of diabetes complications. Among Hispanics and Anglos in San Antonio, Texas, complications of diabetes were not related to socioeconomic status (33). No association of glycemic control with income or education was found in Caucasians, African-Americans, or Mexican-Americans in NHANES III (34).…”

Section: ) Hypertensivementioning

confidence: 78%

Racial and Ethnic Differences in Health Care Access and Health Outcomes for Adults With Type 2 Diabetes

2001

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OBJECTIVE -To evaluate health care access and utilization and health status and outcomes for type 2 diabetic patients according to race and ethnicity and to determine whether health status is influenced by health care access and utilization.RESEARCH DESIGN AND METHODS -National samples of Caucasians, AfricanAmericans, and Mexican-Americans were studied in the third National Health and Nutrition Examination Survey. Information on medical history and treatment of diabetes, health care access and utilization, and health status and outcomes was obtained by structured questionnaires and by clinical and laboratory assessments.RESULTS -Almost all patients in each race and ethnic group had one primary source of ambulatory medical care (92-97%), saw one physician at this source (83-92%), and had at least semiannual physician visits (83-90%). Almost all patients Ն65 years of age had health insurance (99 -100%), and for those patients Ͻ65 years of age, Caucasians (91%) and African-Americans (89%) had higher rates of coverage than Mexican-Americans (66%). Rates of treatment with insulin or oral agents (71-78%), eye examination in the previous year (61-70%), blood pressure check in the previous 6 months (83-89%), and the proportion of hypertension that was diagnosed (84 -91%) were similar for each race and ethnic group. Lower proportions of AfricanAmericans and Mexican-Americans self-monitored their blood glucose (insulin-treated, 27 vs. 44% of Caucasians), had their cholesterol checked (62-68 vs. 81%), and had their dyslipidemia diagnosed (45 vs. 58%). African-American and Mexican-American patients had a somewhat higher proportion than Caucasian patients, with HbA 1c Ն7% (58 -66 vs. 55%), blood pressure Ն140/90 mmHg among those with diagnosed hypertension (60 -65 vs. 55%), and clinical proteinuria (11-14 vs. 5%). In contrast, they had better levels of total cholesterol (Ն240 mg/dl) (28 -30 vs. 34%) and HDL cholesterol (Ն45 mg/dl) (46 -59 vs. 38%), and African-American and Mexican-American men were less overweight than Caucasian men (BMI Ն30) (34 -37 vs. 44%), although the opposite was true for women. LDL cholesterol levels and the proportion of patients who smoked cigarettes or were hospitalized in the past year were similar among all three groups. In logistic regression analysis, there was little evidence that levels of blood glucose, blood pressure, lipids, or albuminuria were associated with access to or utilization of health care or with socioeconomic status.CONCLUSIONS -There are some differences by race and ethnicity in health care access and utilization and in health status and outcomes for adults with type 2 diabetes. However, the magnitude of these differences pale in comparison with the suboptimal health status of all three race and ethnic groups relative to established treatment goals. Health status does not appear to be influenced by access to health care. Diabetes Care 24:454 -459, 2001

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Section: ) Hypertensivementioning

confidence: 78%

Racial and Ethnic Differences in Health Care Access and Health Outcomes for Adults With Type 2 Diabetes

2001

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“…24 Similarly, hispanics have been suggested to have higher prevalence of diabetic retinopathy, although factors that may explain differences between hispanics and whites are less clear. 19,20,26 In one study, despite adjustment for glycemic levels and other risk factors, diabetic retinopathy was still twice as common in hispanics living in San Antonio, Texas, USA as compared with whites in Madison, Wisconsin, USA. 19 Similarly, in the NHANES III, despite controlling for duration of diabetes and levels of glycemia and blood pressure, hispanics had higher prevalence and more severe retinopathy than whites in that study.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Retinopathy in a Multi-ethnic Cohort in the United States

Wong

Klein

Islam

et al. 2006

American Journal of Ophthalmology

579

437

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PURPOSE-To describe the prevalence and risk factors of diabetic retinopathy in a multi-ethnic US population of whites, blacks, hispanics, and chinese. DESIGN-Cross-sectional study of 778 individuals from ages 45 to 85 years with diabetes, participating in the Multi-Ethnic Study of Atherosclerosis (MESA).METHODS-Retinal photographs were obtained with a 45° nonmydriatic digital fundus camera. Presence and severity of diabetic retinopathy were graded at a central reading center on the basis of a modification of the Airlie House classification system. All participants underwent a standardized interview, examination, and laboratory investigations.RESULTS-In this population with diabetes, the prevalence of any retinopathy was 33.2% and macular edema 9.0%. The prevalence of any diabetic retinopathy and macular edema was significantly higher in blacks (36.7% and 11.1%) and hispanics (37.4% and 10.7%) than in whites (24.8% and 2.7%) and chinese (25.7% and 8.9%) (P = .01 and P = .007, comparing racial/ethnic differences for retinopathy and macular edema, respectively). Significant independent predictors of any retinopathy were longer duration of diabetes, higher fasting serum glucose, use of diabetic oral medication or insulin, and greater waist-hip ratio. Race was not an independent predictor of any retinopathy.CONCLUSIONS-This study provides contemporary data on the prevalence of and risk factors for diabetic retinopathy among whites, blacks, hispanics, and chinese participating in the MESA.Diabetic retinopathy, the most common specific complication of type 2 diabetes, is the leading cause of blindness among Americans age 20 to 64 years. 1,2 The epidemiology of diabetic retinopathy has been previously described, largely in white populations. 3-6 In the Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR), the prevalence of retinopathy in 1980 to 1982 among persons with type 2 diabetes was reported at 39% for those not receiving insulin treatment, and 70% for those receiving insulin treatment. 3 A recent review of data In contrast to whites, there are fewer population-based data on either the prevalence of or the risk factors for retinopathy in other racial/ethnic groups with diabetes in the United States. 17-20 Because diabetes prevalence appears to vary between these racial/ethnic groups, 21-23 it has been suggested that the frequency of retinopathy may also vary by race/ethnicity. The few studies conducted suggest that in comparison to studies in whites, African Americans (blacks) and hispanics have a higher prevalence of retinopathy. 24-26 These differences have been attributed in part to racial/ethnic differences in diabetes duration, glycemic control, and blood pressure levels in blacks, but not in hispanics. There are no data on the epidemiology of diabetic retinopathy in Chinese Americans (chinese).The purposes of our current study were to describe the prevalence of diabetic retinopathy among whites, blacks, hispanics, and chinese diagnosed with diabetes participating in the Multi-Ethnic Study ...

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“…25,45,52,60,61,[65][66][67]69,70,124,126,141,146,164 Of these, only five were comparative studies between ethnic groups. 52,65,67,69,70 One study reported a similar prevalence in Hispanics and non-Hispanic whites, 52 whereas the remaining four reported differences between blacks, whites, Mexicans, and Hispanics.…”

Section: Ethnic Variationmentioning

confidence: 99%

Epidemiology of diabetic retinopathy and macular oedema: a systematic review

Williams

Airey

Baxter

et al. 2004

Eye

400

243

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Aims To systematically review the literature on the prevalence and incidence of diabetic retinopathy (DR) and macular oedema (MO). Methods A search of the bibliographic databases (Medline, Embase, CINAHL) was conducted up to October 2001. Selected relevant studies were scrutinized and included in the review. Results A total of 359 studies were included. The studies were reported in nearly 100 different journals and in over 50 countries. The majority of the studies were US-based, with large studies such as the Wisconsin Epidemiologic Study of Diabetic Retinopathy dominating the literature. The studies were quite dated and highly heterogeneous in nature in terms of patient selection with variable inclusion criteria (age range, gender, diabetes duration and type, ethnicity, comorbidity, and DR status, assessment, and classification). Conclusions There are inconsistencies between epidemiological studies, and differences in study methods may contribute to conflicting reports of prevalence and incidence of DR and MO in diabetic populations. As new therapies for DR and its associated complications emerge, the need to capture and monitor new epidemiological data becomes increasingly important to be able to assess the impact and effectiveness of these therapies. Robust, longitudinal capture of patient data is, therefore, essential to evaluate the impact of current practice on the epidemiology of diabetic eye complications.

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Effect of Socioeconomic Status on Hyperglycemia and Retinopathy Levels in Mexican Americans With NIDDM

Cited by 73 publications

References 10 publications

Racial and Ethnic Differences in Health Care Access and Health Outcomes for Adults With Type 2 Diabetes

Racial and Ethnic Differences in Health Care Access and Health Outcomes for Adults With Type 2 Diabetes

Diabetic Retinopathy in a Multi-ethnic Cohort in the United States

Epidemiology of diabetic retinopathy and macular oedema: a systematic review

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