Fairless Elizabeth, Garbrecht Jarret, Powell Zachary, Ding Kai, Kingsley Ronald, Farris Bradley
Dean McGee Eye Institute, University of Oklahoma, 608 Stanton L Young Blvd, Oklahoma City, OK, 73104, USA.
College of Medicine, University of Oklahoma, Oklahoma City, OK, USA.
J Racial Ethn Health Disparities. 2024 Dec 10. doi: 10.1007/s40615-024-02256-x.
Native Americans (NAs) have the highest prevalence of diabetes mellitus (DM) of any racial group in the USA and are therefore at higher risk for diabetic retinopathy (DR) and diabetic macular edema (DME). This study estimated the prevalence of DR and DME among NAs receiving eye exams at the Citizen Potawatomi Nation (CPN) clinic, a tribal clinic in Oklahoma serving members of multiple tribes, and characterized risk markers associated with the presence and severity of DR.
A retrospective chart review identified tribal members with DM who received dilated retinal fundus exams at the CPN clinic between 2021 and 2023. The presence and stage of DR and DME among participants were recorded. Hypotheses of association between the presence or severity of DR and medical and socioeconomic factors were tested.
Among the 504 participants, the prevalence of DR was 19.4% (95% CI 16.1-23.2%), including 16.3% (95% CI 13.2-19.8%) with non-proliferative DR and 3.2% (95% CI 1.8-5.1%) with proliferative DR, and 3.4% (95% CI 2.0-5.4%) with DME. Nephropathy, longer duration of DM, higher HbA1c, insulin use, and Medicaid insurance were associated with the presence of DR (p < 0.05).
This study found a lower prevalence of DR than did earlier studies of NAs with DM. The mean HbA1c in this cohort was lower than in earlier studies, suggesting that diabetes management has improved. Several medical or socioeconomic factors were associated with the presence and severity of DR.
在美国，美国原住民（NA）是所有种族群体中糖尿病（DM）患病率最高的，因此患糖尿病性视网膜病变（DR）和糖尿病性黄斑水肿（DME）的风险更高。本研究估计了在公民波塔瓦托米民族（CPN）诊所接受眼部检查的美国原住民中DR和DME的患病率，CPN诊所是俄克拉荷马州的一家部落诊所，为多个部落的成员提供服务，并确定了与DR的存在和严重程度相关的风险标志物。
一项回顾性病历审查确定了2021年至2023年期间在CPN诊所接受散瞳视网膜眼底检查的患有DM的部落成员。记录了参与者中DR和DME的存在情况和阶段。检验了DR的存在或严重程度与医学和社会经济因素之间的关联假设。
在504名参与者中，DR的患病率为19.4%（95%CI 16.1 - 23.2%），其中非增殖性DR为16.3%（95%CI 13.2 - 19.8%），增殖性DR为3.2%（95%CI 1.8 - 5.1%），DME为3.4%（95%CI 2.0 - 5.4%）。肾病、DM病程较长、糖化血红蛋白（HbA1c）较高、使用胰岛素和参加医疗补助保险与DR的存在相关（p < 0.05）。
本研究发现，与早期对患有DM的美国原住民的研究相比，DR的患病率较低。该队列中的平均HbA1c低于早期研究，表明糖尿病管理有所改善。一些医学或社会经济因素与DR的存在和严重程度相关。
