Abstract
Purpose: :
Persons of African American (AA) ethnicity remain at risk for a variety of health and visual conditions. Work designed to elucidate factors associated with these risks may provide benefits in managing health concerns. We hypothesize that a variety of cultural and physical factors act to cause differences as well as maintain some similarities in two ethnically-similar populations located in diverse settings, one in rural Alabama and the other in urban Chicago, Illinois.
Methods: :
The Rural Alabama Diabetes and Glaucoma Initiative, in conjunction with the Black Belt Eye Care Consortium, completed 42 vision care projects in the Black Belt of rural Alabama during a 5 year period. A total of 3001 self-selected persons received a variety of demographic, historical, systemic and visual examination as well as appropriate management. AA ethnicity was self-reported by 2386 (79.4%). The Vision of Hope Health Alliance provides comprehensive vision and health care to under-privileged persons in urban Chicago, Illinois. AA ethnicity was self-reported by 1822 persons (45.2%) of a total of 4029 seen in a 4 year period. All individuals in both settings gave informed consent prior to enrolling.
Results: :
A total of 4208 persons aged 18 to 84 yrs self-identified as AA ethnicity were included in the analysis. Participants in the urban setting had greater educational levels (88.0 vs. 67.4%, completed high school or some college; chi square, p<0.0001); a greater prevalence of smoking (37.3 vs. 15.3 %, chi square test, p<0.0001) and diabetes (20.6 vs. 15.4% p<0.0001). The patients in the rural setting had a greater proportion of females (1765 females (74.0%) vs. 972 in the urban setting (53.4%); chi square test, p<0.0001); greater levels of employment (42.6 vs. 37.3%, chi square test, p=0.005), more likely to have obtained medical care within 1 yr (97% vs. 61%, chi square test, p<0.0001); greater proportion with an eye exam within 2 yrs (61.0 vs. 33.8%, chi square test, p<0.0001); and, dramatically greater self-reported hypercholesterolemia (38.5 vs. 4.4%, chi square test, p<0.0001). The two populations self-reported a similar prevalence of hypertension; 43.4 vs. 45.4%; chi square test, p = NS).
Conclusions: :
These data suggest that cultural influences (female/male ratio, smoking, access to medical care / eye exams and prevalence of hypercholesterolemia, diabetes) and physical location (education, employment) play a role in the health outcomes of AA patients. Other factors may be less affected by culture or location (hypertension).
Keywords: clinical (human) or epidemiologic studies: risk factor assessment • clinical (human) or epidemiologic studies: health care delivery/economics/manpower