Diabetic Retinopathy, Dilated Eye Examination, and Eye Care Education Among African Americans, 1997 and 2004

• Published in: Journal of the National Medical Association Vol. 101; no. 10; pp. 1015 - 1021
• Main Authors: Zhang, Xinzhi, MD, PhD, Williams, Desmond E., MD, PhD, Beckles, Gloria L., MD, MSc, Gregg, Edward W., PhD, Barker, Lawrence, PhD, Luo, Huabin, PhD, Rutledge, Stephanie A., PhD, Saaddine, Jinan B., MD, MPH, for Project DIRECT Evaluation Study Group
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 01-10-2009; National Medical Association; Elsevier Limited
• Subjects: Adolescent; Adult; African Americans; Aged; Biological and medical sciences; Cross-Sectional Studies; diabetes mellitus; Diabetes. Impaired glucose tolerance; Diabetic Retinopathy - ethnology; Diabetic Retinopathy - prevention & control; Diagnostic Techniques, Ophthalmological; Dilatation; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; General aspects; Health Behavior; Humans; Internal Medicine; Medical sciences; Middle Aged; ophthalmic; Ophthalmology; Patient Education as Topic; Retinopathies; Young Adult; African Americans; ophthalmic; diabetes mellitus; Endocrinopathy; Human; Retinopathy; Diabetes mellitus; Care; Teaching; Medicine; Eye; Visual system; 1997; Eye disease; 2004; Education; African American
• ISSN: 0027-9684; 1943-4693
• DOI: 10.1016/S0027-9684(15)31068-3

Objective To examine diabetic retinopathy, dilated eye examination, and eye care education among African Americans before and after a community-level public health intervention. Methods We analyzed data from Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together) participants with self-reported diabetes (617 in 1996-1997 and 672 in 2003-2004) in Raleigh (intervention community) and Greensboro (comparison community), North Carolina. All analyses were weighted to adjust for the complex sample design of pre and post cross-sectional surveys. Estimates were age standardized to the 2000 US Census population. We used multivariate logistic regression to calculate odds ratios and corresponding 95% confidence intervals. Results We found no significant difference in prevalence of diabetic retinopathy between the control and intervention communities ( p > .05). However, after adjusting for other confounders, receipt of eye care education (OR, 1.59; 95% CI, 1.19-2.13) was independently associated with receipt of dilated eye examination among African Americans with diabetes. Compared with individuals without diabetic retinopathy, those with diabetic retinopathy were more likely to use eye care services (OR, 1.89; 95% CI, 1.41-2.54). Conclusions Diabetic retinopathy is a considerable problem among African American communities. Community intervention efforts, such as comprehensive eye care education, that specifically target improvement in diabetic retinopathy and use of eye care services could help better serve this population.