Drinkwater Jocelyn J, Davis Wendy A, Turner Angus W, McAullay Daniel, Davis Timothy M E
Medical School, The University of Western Australia, Fremantle Hospital, Perth, Western Australia, Australia.
Lions Eye Institute, Perth, Western Australia, Australia.
Intern Med J. 2022 Apr;52(4):590-598. doi: 10.1111/imj.15090.
Indigenous populations have higher rates of diabetes and diabetic complications, yet there is a paucity of contemporary data on diabetic retinopathy (DR) prevalence and incidence in urban dwelling Aboriginal Australians.
The aim of the study was to compare the prevalence of DR and incidence of new or worsening DR between Aboriginal Australians and Anglo-Celts with Type 2 diabetes.
Participants from the community-based Fremantle Diabetes Study Phase II (817 Anglo-Celts, 94 Aboriginal people) recruited between 2008 and 2011 underwent fundus photography at baseline and biennial reviews. The prevalence of any DR and moderate non-proliferative DR (NPDR), and the incidence of new or worsening DR were ascertained using baseline and 4-year follow-up data.
Compared with Anglo-Celts, the Aboriginal participants had a higher prevalence of any DR (33.0% vs 52.1%) and moderate NPDR or worse (5.1% vs 24.4%), and new or worsening DR during follow up (6.7% vs 23.5%). The unadjusted odds ratios (95% confidence interval) of any DR and moderate NPDR at baseline were 2.21 (1.43, 3.39) and 5.98 (3.40, 10.50), respectively, and of new or worsening DR 4.32 (1.33, 13.98). In adjusted models, Aboriginal ethnicity was only associated with the prevalence of moderate NPDR or worse (5.58 (2.44, 12.76)).
Aboriginal participants had a higher prevalence of DR and new or worsening DR, reflecting conventional risk factors including suboptimal glycaemic control. Their significantly higher odds of moderate NPDR or worse in adjusted models suggest ethnic-specific determinants of DR severity. These findings highlight the need for equitable, culturally appropriate diabetes/ophthalmic care.
原住民糖尿病及糖尿病并发症的发病率较高，但目前关于居住在城市的澳大利亚原住民糖尿病视网膜病变（DR）患病率和发病率的当代数据较少。
本研究旨在比较澳大利亚原住民和英裔凯尔特人2型糖尿病患者的DR患病率以及新发或病情恶化的DR发病率。
2008年至2011年招募的社区弗瑞曼特尔糖尿病研究二期参与者（817名英裔凯尔特人、94名原住民）在基线和每两年一次的复查时接受眼底照相。利用基线和4年随访数据确定任何DR和中度非增殖性DR（NPDR）的患病率以及新发或病情恶化的DR发病率。
与英裔凯尔特人相比，原住民参与者任何DR的患病率更高（33.0%对52.1%），中度NPDR及以上的患病率更高（5.1%对24.4%），随访期间新发或病情恶化的DR发病率更高（6.7%对23.5%）。基线时任何DR和中度NPDR未经调整的优势比（95%置信区间）分别为2.21（1.43，3.39）和5.98（3.40，10.50），新发或病情恶化的DR为4.32（1.33，13.98）。在调整模型中，原住民种族仅与中度NPDR及以上的患病率相关（5.58（2.44，12.76））。
原住民参与者DR以及新发或病情恶化的DR患病率更高，这反映了包括血糖控制欠佳在内的传统风险因素。在调整模型中，他们中度NPDR及以上的显著更高优势比表明存在DR严重程度的种族特异性决定因素。这些发现凸显了提供公平、符合文化习惯的糖尿病/眼科护理的必要性。
