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K. M. Daum, J. E. Winters; Comparison of Systemic and Visual Findings in African Americans in Rural and Urban Settings. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5354.
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© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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).
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).
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