Retinal and systemic disease of Native Americans in the Intermountain West

Abstract

Purpose : The Navajos and Goshutes are underserved patient populations residing in 4-Corners (UT, AZ, NM, CO) and Ibupah, UT, respectively. Evaluating comorbidity with eye disease, in these tribes is important because they may have unique paradigms for disease risk and prevention.

Methods : We conducted a cross-sectional study of epidemiological factors that may be associated with Type II diabetes mellitus (DM), hypertension (HBP) and retinal manifestations of both conditions in tribal members and non-tribal members in the study areas. We performed meta-analyses to determine what if any risk factors were unique at the tribal level. Fundus photos and standardized epidemiological questionnaires were collected for participants. In addition, blood samples were collected to analyze lipid biomarkers. Univariate analyses were conducted and statistically significant factors at p<0.10 were entered into a multivariate logistic regression. An adj. p<0.05 was considered statistically significant.

Results : Of 51 participants from the 4-Corners, 31 had DM, 26 had HBP and 6 had diabetic retinopathy (DR). Of the 64 participants from Ibupah, 20 had DM, 19 had HBP and 6 had DR. Using a meta-analysis, being Native American (p=.022), living in the 4-Corners (p=.027) and having HBP (p<.001) increased risk of having DM. DM (p<.001) and Age (p=.002) were associated with HBP. In terms of Retinopathy having HBP (p=.037) and living in Ibupah (p<.001) were associated with greater risk. Observing solely Native Americans from both regions those with HBP were more likely to have DM (p<.001). Furthermore, having DM (p<.001) and being older (p=.018) was associated with greater likelihood of having HBP. Navajos were less likely to have a diagnosis of retinopathy as compared to Goshutes (OR = .059; 95% CI = .016-.223; p=<.001). Associations were found with DM and HBP in all populations. Older age was associated with DM in both the Navajo (p=.003) and 4-Corners populations (p=.004), but not within the Goshutes and the Ibupah population. No biomarkers were found to be associated.

Conclusions : We found different comorbid factors with retinal disease between populations, identifying the need for studies at the tribal level for treatment. This is further indicated by the association of tribe and retinopathy in the meta-analysis of Native Americans. As we understand, this is the first study to conduct a meta-analysis for the outcomes in the Navajo and Goshute tribes.

This is a 2020 ARVO Annual Meeting abstract.