Systemic Disease and Ocular Comorbidity Analysis of Geographically Isolated Federally Recognized American Indian Tribes of the Intermountain West

Abstract

Background: The American Indian Navajo and Goshute peoples are underserved patient populations residing in the Four Corners area of the United States and Ibupah, Utah, respectively. Methods: We conducted a cross-sectional study of epidemiological factors and lipid biomarkers that may be associated with type II diabetes, hypertension and retinal manifestations in tribal and non-tribal members in the study areas (n = 146 participants). We performed multivariate analyses to determine which, if any, risk factors were unique at the tribal level. Fundus photos and epidemiological data through standardized questionnaires were collected. Blood samples were collected to analyze lipid biomarkers. Univariate analyses were conducted and statistically significant factors at p < 0.10 were entered into a multivariate regression. Results: Of 51 participants for whom phenotyping was available, from the Four Corners region, 31 had type II diabetes (DM), 26 had hypertension and 6 had diabetic retinopathy (DR). Of the 64 participants from Ibupah with phenotyping available, 20 had diabetes, 19 had hypertension and 6 had DR. Navajo participants were less likely to have any type of retinopathy as compared to Goshute participants (odds ratio (OR) = 0.059; 95% confidence interval (CI) = 0.016–0.223; p < 0.001). Associations were found between diabetes and hypertension in both populations. Older age was associated with hypertension in the Four Corners, and the Navajo that reside there on the reservation, but not within the Goshute and Ibupah populations. Combining both the Ibupah, Utah and Four Corners study populations, being American Indian (p = 0.022), residing in the Four Corners (p = 0.027) and having hypertension (p < 0.001) increased the risk of DM. DM (p < 0.001) and age (p = 0.002) were significantly associated with hypertension in both populations examined. When retinopathy was evaluated for both populations combined, hypertension (p = 0.037) and living in Ibupah (p < 0.001) were associated with greater risk of retinopathy. When combining both American Indian populations from the Four Corners and Ibupah, those with hypertension were more likely to have DM (p < 0.001). No lipid biomarkers were found to be significantly associated with any disease state. Conclusions: We found different comorbid factors with retinal disease outcome between the two tribes that reside within the Intermountain West. This is indicated by the association of tribe and with the type of retinopathy outcome when we combined the populations of American Indians. Overall, the Navajo peoples and the Four Corners had a higher prevalence of chronic disease that included diabetes and hypertension than the Goshutes and Ibupah. To the best of our knowledge, this is the first study to conduct an analysis for disease outcomes exclusively including the Navajo and Goshute tribe of the Intermountain West.

Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma

“…In this multivariate analysis, we found that both iStent (p < 0.0001) and the number of medications pre-operation (p < 0.001) were statistically associated with the outcome of medication reduction at p < 0.05 (Table 6). We then completed a multivariate analysis with all of the variables of interest, including, age, gender, race/ethnicity, iStent, and pre-SLT IOP [35][36][37][38][39][40]. We found that in the complete multivariate analysis only the initial IOP pre-operation (p < 0.0001) was statistically associated with the outcome of percent IOP reduction post-SLT at p < 0.05 (Table 6).…”

Pseudoexfoliation and Cataract Syndrome Associated with Genetic and Epidemiological Factors in a Mayan Cohort of Guatemala

“…Rural, isolated populations, even with a small study sample size, are essential populations to include in research, because if they are ignored, health disparities will only further increase [ 90 , 105 ]. Future research is needed to validate the genetic findings based on leukocyte DNA from blood.…”

“…Our study did not exclusively observe different Maya cultural groups; therefore, future studies may identify specific wants and needs pertaining to eye health and eye research within the more than 20 different Guatemala Mayan communities that differ by both language and culture [ 156 ]. Our previous research within the American Indian tribes of the Intermountain West has shown that there are differences in the prevalence of blinding eye disease within the same state at the tribal level; therefore, this research is essential to determine differences that may occur between Mayan communities in Guatemala [ 90 , 105 ].…”

“…Furthermore, participants were asked to complete a structured core baseline interview for a standardized epidemiological questionnaire administered by the study team member in conjunction with an interpreter [ 90 , 105 , 106 , 107 , 108 ]. Interpreters provided detailed information and assisted with the consent form and questionnaire in the participants’ native dialect ( Appendix A ).…”

“…Underserved and isolated populations have unique paradigms for disease prevention and risk [ 34 , 89 ]. These populations may experience more significant health disparities due to decreased access to education, nutritional food sources, community and social support, safe neighborhoods, and quality healthcare [ 90 , 91 , 92 ]. Guatemala was able to eliminate onchocerciasis, or river blindness [ 93 ].…”