Original article
Risk factors for type ii diabetes and diabetic retinopathy in a mexican-american population: proyecto ver

https://doi.org/10.1016/S0002-9394(02)01595-7Get rights and content

Abstract

PURPOSE: Risk factors for type II diabetes and diabetic retinopathy were determined in a population-based study of Mexican-Americans.

DESIGN: Proyecto VER (Vision, Evaluation, and Research) is a cross-sectional study in a random sample of the self-described Hispanic populations in Tucson and Nogales, Arizona, age 40 and older.

METHODS: Of 6,659 eligible subjects, 4,774 (72%) participated in the home questionnaire and clinic visit. Diabetes was defined as self-report of a physician diagnosis or hemoglobin A1c value of ≥ 7.0%. Only type II diabetes was included. Diabetic retinopathy was assessed on stereo fundus photographs of all persons with diabetes. Questions were asked about demographic, personal, socioeconomic, and diabetes related variables.

RESULTS: 1023 (21.4%) of the sample had type II diabetes, and 68% were in the low-income group (annual income less than $20,000). Diabetes was associated with Native-American ancestry, higher acculturation, low income, less education, and increasing body mass index after age and gender adjustment. Persons with previously undiscovered diabetes were more likely to have no regular source of care, no insurance, and currently smoke compared with persons with known diabetes. Only low income was related to proliferative retinopathy, once adjusted for other factors (odds ratio [OR] = 3.93, 95%, confidence limitations [CL] = 1.31–11.80).

CONCLUSIONS: Several socioeconomic and other factors were associated with diabetes, but few were related to diabetic retinopathy. Persons in the low-income group appeared to be at greater risk of diabetes and the ocular complications of diabetes compared with those with more income. Further longitudinal studies in this population are needed to confirm the associations.

Section snippets

Study population

Proyecto VER [Proyecto (Spanish for “project”) VER (Vision, Evaluation, and Research; VER is Spanish for “see”)] is a population-based cross-sectional survey of noninstitutionalized Mexican-Americans age 40 and older living in Arizona. Proyecto VER population selection and recruitment has been described in detail elsewhere.7 In summary, based on the 1990 census, a random sample of block groups that contained at least 5% Hispanic (according to census designation) residents age 40 and older were

Results

A total of 4,774 persons participated in the project (a participation rate of 72%). Detailed differences between participants and nonparticipants are reported elsewhere.7 In general, nonparticipants were significantly more likely to be male (46% vs 39%) and older (19% age 70+ vs 17%). Nonparticipants were also less likely to report having diabetes, but the age-adjusted differences were not significant.

A total of 1,023 (21% of 4,774) persons had diabetes, of whom 159 (16%) were not aware of

Discussion

In our sample of Mexican-Americans with type II diabetes, demographic, personal, socioeconomic, and access to care factors were more strongly associated with diabetes, especially previously undiagnosed diabetes, than with the retinopathy of diabetes. Only low income, less than $20,000/year, was related to proliferative retinopathy after adjustment for age, gender, duration of diabetes, and insulin use. Lack of insurance and no regular source of care were associated with previously undiagnosed

Acknowledgements

We are grateful to Dr. Michael Steffes and Dr. Richard Royall for their advice and assistance and to the Team of Proyecto VER for their skill and support. We also thank Stacey Meuer for her help on the project.

References (22)

  • M.P Stern et al.

    Genetic and environmental determinants of type II diabetes in Mexican-Americans

    Diabetes Care

    (1991)
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