RESUMO
BACKGROUND: Latinos have one of the highest rates of visual impairment associated with eye disease in the United States. Although little is known about the prevalence and risk of undetected eye disease (UED) in this population, it is known that Latinos encounter disproportionate barriers in accessing health care, which may influence the burden of UED. OBJECTIVE: To estimate the burden and to evaluate factors associated with UED among Latinos, a majority of whom were Mexican-American. RESEARCH DESIGN: Population-based, cross-sectional study. A detailed interview and eye examination were performed on participants. SUBJECTS: A sample of 6,357 Latinos (95% of whom had Mexican ancestry), aged >or=40, in 6 census tracts in Los Angeles, California. MAIN OUTCOME MEASURE: UED (macular degeneration, glaucoma, diabetic retinopathy, cataract, and refractive error) was defined as those persons with eye disease and no reported history of that eye disease. RESULTS: Fifty-three percent (3,349 of 6,357) of the participants had eye disease. Sixty-three percent (2,095 of 3,349) of them had UED. Major risk factors for UED included older age [odds ratio (OR): 4.7 (age >or=80)], having diabetes mellitus (OR: 3.3), never having had an eye examination (OR: 2.4), being uninsured (OR: 1.6), lower educational attainment (OR: 1.4), and low acculturation (OR: 1.3). CONCLUSIONS: These findings provide evidence of the burden of UED among Latinos. Interventions that address the modifiable risk factors (lack of insurance, never having had an eye examination, etc.) may improve detection of eye disease and decrease the burden of visual impairment in this high-risk minority population.
Assuntos
Oftalmopatias/etnologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Americanos Mexicanos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Complicações do Diabetes/etnologia , Oftalmopatias/diagnóstico , Oftalmopatias/etiologia , Feminino , Disparidades em Assistência à Saúde , Humanos , Entrevistas como Assunto , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de RiscoAssuntos
Atitude Frente a Saúde/etnologia , Neoplasias Pulmonares/etnologia , Americanos Mexicanos/psicologia , Relações Médico-Paciente , Revelação da Verdade , Idoso , Anedotas como Assunto , Antropologia Cultural , Atitude Frente a Morte/etnologia , Bioética , Tomada de Decisões , Humanos , Entrevistas como Assunto , Los Angeles , Neoplasias Pulmonares/psicologia , Masculino , Sociologia Médica , Assistência TerminalRESUMO
OBJECTIVE: To determine the effects of a culturally appropriate diabetes lifestyle intervention for Native Americans on risk factors for complications of diabetes. RESEARCH DESIGN AND METHODS: A nonrandomized, community-based diabetes intervention trial was conducted in three Native American sites in New Mexico from 1993-1997. Participants were assigned to intervention or control based on community of residence. Intervention sessions were held approximately 6 weeks apart over approximately 10 months. The intervention was delivered in site A in family and friends (FF) groups (n = 32); site B received the same intervention in one-on-one (OO) appointments (n = 39); and site C received usual medical care (UC) (n = 33) (total participants, n = 104). Primary change in HbA(1c) level was assessed at 1 year. RESULTS: Adjusted mean change in HbA(1c) value varied significantly across the three arms at 1 year (P = 0.05). The UC arm showed a statistically significant increase in adjusted mean HbA(1c) change (1.2%, P = 0.001), whereas both intervention arms showed a small nonsignificant (P > 0.05) increase in the adjusted mean change (0.5% and 0.2% for FF and OO arms, respectively). The increase was statistically significantly smaller in the combined intervention arms (0.4%) compared with the UC arm (1.2%, P = 0.02). CONCLUSIONS: Lifestyle intervention has the potential to substantially reduce microvascular complications, mortality, and health care utilization and costs if the change is sustained over time.