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Roberta McKean-Cowdin, mina torres, Bruce Burkemper, Alicia Fairbrother-Crisp, Xuejuan Jiang, Farzana Choudhury, Tien Y Wong, Rohit Varma; Prevalence and Risk Factors for DR in the African American Eye Disease Study. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1089.
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To characterize the prevalence and identify risk factors associated with diabetic retinopathy (DR) and diabetic macular edema (DME) in adult African Americans with diabetes.
A population-based sample of 6,347 African American adults (ages 40+ years), residing in 32 census tracts in Los Angeles County, CA was assembled from 2014-2018. Participants completed an in-home interview on socio-demographics, medical history, health care use and a comprehensive clinical eye examination. Fundus photographs from 7 Early Treatment Diabetic Retinopathy fields were graded in a masked fashion using a modified Airlie House grading system to assess presence and severity of DR and DME. Vision threatening DR (VTDR) was defined as presence of severe non-proliferative DR (NPDR) or worse and/or DME. Age-specific, sex-specific, and age-standardized prevalence measures were calculated overall and by duration of diabetes. Risk factors for prevalent DR were evaluated using multivariate logistic regression to calculate odds ratios(ORs) and 95% confidence intervals (CIs) based on a-priori conceptual models of DR.
Among persons with diabetes, the prevalence of any DR was 31.5% (95%CI 28.7%, 34.2%). The prevalence of mild, moderate, severe NPDR and proliferative (PDR) was: 8.5%, 16.9%, 0.92%, and 5.3% respectively. The prevalence of any DME was 7.0% (95%CI 5.5%,8.5%) and was significantly lower for adults 60-69(6.8%) and 70-79(3.3%) years compared to those 40-59(10.5%). There was a positive association between prevalence of any DR and any DME with longer duration of diabetes (5-year intervals) ranging from 10.2% (newly diagnosed) to 49.5% (15+years) for DR and 6.0% to 52.2% for DME. Approximately one-third of PDR(30%), VTDR(32%), and DME(26%) were newly diagnosed. Both DR and VTDR were associated with longer T2DM duration (OR=2.32, 2.52, 2.96, and 5.85, for duration 0-4, 5-9, 10-14 and 15+ years vs newly diagnosed, respectively), higher glycosylated hemoglobin (HbA1c) levels (OR=1.14, 1.71, 2.44, for HbA1c levels 6.5-6.9%, 7-7.9% and 8+% vs <6.5%), and insulin treatment (OR=2.47).
AFEDS provides the first, population-based prevalence and risk factor data in recent decades to characterize DR and DME in African Americans. A high proportion of diabetic African Americans with VTDR and PDR remain previously undiagnosed indicating an unmet need for regular comprehensive eye examinations among this susceptible population.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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