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R. Varma, R. Klein, S.K. West, M. Torres, B. Klein, B. Munoz, S. Azen, S. Moss; Are Latinos at Greater Risk for Diabetic Retinopathy Than Whites? Pooled Findings From 3 Population–based Studies . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1164.
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Purpose: To examine whether Latinos with Type 2 Diabetes (T2DM) are at higher risk of having Diabetic Retinopathy (DR) and Proliferative Diabetic Retinopathy (PDR) than Non–Hispanic Whites (NHWs)with T2DM. Methods: Pooled data were obtained for persons of two ethnic groups, aged 40 years and older with T2DM, from 3 population–based studies – Beaver Dam Eye Study (BDES)(NHWs), Proyecto VER (PVER)(Arizona Latinos), Los Angeles Latino Eye Study (LALES)(Los Angeles Latinos). All participants underwent an interview and a clinical examination including history of diabetes duration, smoking, medication use, measurement of glycosylated hemoglobin (Hba1c), blood pressure, and stereoscopic fundus photography. Photographs were graded in a masked manner using a modified Airlie House classification to assess presence/severity of diabetic retinopathy. Protocols and definitions were similar across the three studies. Chi–square analyses were conducted to assess the univariate association of risk indicators (duration of diabetes, insulin use, and categories of acculturation, BMI, Hba1c, smoking, blood pressure) with any diabetic retinopathy (none vs. DR), and PDR (non–PDR vs. PDR), stratified by study (BDES, PVER, LALES) and ethnicity (NHWs and Latinos). When stratified by ethnicity the LALES population and Proyecto VER population were combined to represent one group (Latino). Risk indicators were evaluated using forward and backward stepwise logistic regression, with and without ethnicity in the model. Results: In the pooled cohort, 2501 persons with T2DM were included – 414 from BDES, 900 from PVER and 1187 from LALES. The crude prevalence of any DR was higher in Latinos (46%) compared to NHWs (36%), p<0.0001. Latinos also had a higher crude prevalence of severe NPDR (4%) and PDR (6%), compared with NHWs (1%, 2%, respectively), p<0.0001. After adjusting for all significant risk indicators in the logistic regression model, the risk of any DR in Latinos was twice that of NHWs (OR: 2.2, 95% CI 1.7–2.9) and the risk for PDR was almost seven times higher in Latinos than NHWs (OR: 6.9, 95% CI 2.7–17.9)(p<0.0001). Conclusions: This study provides evidence of a higher risk of both DR and PDR in Latinos than NHWs with T2DM not explained by traditional risk factors. One possible explanation may be a greater genetic susceptibility in Latinos to develop DR and PDR compared to NHWs.
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