Self-reported eye diseases among American Indian individuals with type 2 diabetes from the northern Midwest.

To estimate the prevalence of cataract, glaucoma, age-related maculopathy (ARM) and diabetic retinopathy (DR) in the adult Finnish population. A representative cross-sectional sample of the Finnish population aged 30 years and older. Of the 7979 eligible people, 7413 (93%) were interviewed and/or examined. The interview included self-reported doctor-made diagnoses of cataract, glaucoma, degenerative fundus changes (mainly ARM) or DR. Information on self-reported eye diseases was complemented with data from national registers, and case records were gathered for non-participants and persons with visual acuity (VA) < 0.5 or reporting difficulties in vision or eye diseases without assessed VA. Based on self-reported and/or register-based data the estimated total prevalences of cataract, glaucoma, ARM and DR in the study population were 10%, 5%, 4% and 1%, respectively. All these chronic eye diseases increased with age (p < 0.001). The corresponding prevalences for persons aged 65 and older were 34%, 13%, 12% and 2%, respectively. Cataract and glaucoma were more common in women than in men [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.26-1.91; OR 1.57, 95% CI 1.24-1.98, respectively]. The most prevalent eye diseases in people with visual impairment (VA < or = 0.25) were ARM (37%), unoperated cataract (27%), glaucoma (22%) and DR (7%). The high prevalence of these mainly age-related eye diseases, together with increasing life expectancy, mean that continuous efforts are needed to identify and treat eye diseases in order to maintain patients' quality of life and to alleviate the social and economic burden of serious eye diseases.

Purpose: Few studies have provided population-based estimates of the vision impairment, eye disease and eye care in the United States. Using data from the Behavioral Risk Factor Surveillance System (BRFSS) this study reports the overall and age-race-specific prevalence of self-reported vision impairment, eye diseases, and eye care utilization among older adults.Methods: Between 2005 and 2008 residents aged 50 and older in 17 states responded to BRFSS questions concerning difficulty with distance and near vision-related tasks, self-reported eye diseases and reported eye care insurance and service utilization.Results: The overall prevalence of difficulty with distance and near vision was 16.6 and 32.8%, respectively with no meaningful change with increasing age. The prevalence of cataract, glaucoma, and macular degeneration was 19.6%, 6.4, and 5.8%; all of which increased dramatically with age. Nearly 69% of Whites and Blacks and 65% of Hispanics visited an eye care provider in the past year. Overall, among the approximately one-third of participants who did not visit an eye care provider in the past year, half indicated that they did not have any reason to go and 20% cited it was due to cost/insurance.Conclusion: The continued and expanding use of the BRFSS Visual Impairment and Access to Eye Care module represents a unique opportunity to obtain population-based estimates of vision impairment, eye disease and perhaps most uniquely, eye care utilization. Moreover, the integration of this and other BRFSS modules will provide researchers the opportunity to evaluate the relationship between these estimates and other measures of health status and health care utilization. However, the self-reported nature of the BRFSS data is an important limitation that must be considered when interpreting the results.

This study explores the experiences of grief and identity development of American Indian individuals following foster care and adoption compared to their non-American Indian White counterparts. Secondary data analysis was utilized to explore differences in grief and identity development among formerly fostered and adopted American Indian ( n = 129) and White ( n = 166) individuals. Chi-square and logistic regression analyses suggested a significant relationship between race and grief. More American Indian participants reported experiencing grief because of their time in foster care or adoption than did non-American Indian White participants. The relationship between race and level of impact of adoption on identity development was statistically significant in both a t test and ordinary least squares regression. American Indian participants’ identity was more significantly impacted by adoption than their White peers. Findings suggest a need for attention to the unique grief experiences and identity development of adopted and fostered American Indian individuals.

Cardiovascular disease is the leading cause of pregnancy-related death in the United States. American Indian and Alaska Native individuals have some of the highest maternal death and morbidity rates. Data on the causes of cardiovascular disease-related death in American Indian and Alaska Native individuals are limited, and there are several challenges and opportunities to improve maternal cardiovascular health in this population. This scientific statement provides an overview of the current status of cardiovascular health among American Indian and Alaska Native birthing individuals and causes of maternal death and morbidity and describes a stepwise multidisciplinary framework for addressing cardiovascular disease and cerebrovascular disease during the preconception, pregnancy, and postpartum time frame. This scientific statement highlights the American Heart Association's factors for cardiovascular health assessment known collectively as Life's Essential 8 as they pertain to American Indian and Alaska Native birthing individuals. It summarizes the impact of substance use, adverse mental health conditions, and lifestyle and cardiovascular disease risk factors, as well as the cascading effects of institutional and structural racism and the historical trauma faced by American Indian and Alaska Native individuals. It recognizes the possible impact of systematic acts of colonization and dominance on their social determinants of health, ultimately translating into worse health care outcomes. It focuses on the underreporting of American Indian and Alaska Native disaggregated data in pregnancy and postpartum outcomes and the importance of engaging key stakeholders, designing culturally appropriate care, building trust among communities and health care professionals, and expanding the American Indian and Alaska Native workforce in biomedical research and health care settings to optimize the cardiovascular health of American Indian and Alaska Native birthing individuals.

Knowledge of the epidemiology of eye disease among the elderly becomes increasingly important as our population ages. Leading causes of blindness in the elderly include age-related macular degeneration, open-angle glaucoma and cataract. Few studies have examined the prevalence of these blinding eye diseases among senior citizens. A retrospective review of vision screening examinations from 429 patients seen at the UCLA Mobile Eye Clinic in visits to a Jewish senior citizens' center was performed to examine the distribution of best recorded visual acuity and prevalence of eye disease in a group of ambulatory Jewish senior citizens. Best recorded visual acuity was > or = 20/40 in the better eye for 83.9% of the patients. The prevalence of age-related macular degeneration was 20.7%, and increased with increasing age (p < .00005). The prevalence of open-angle glaucoma was 6.3%. The prevalence of senile cataract was 59.0% and increased with increasing age (p < .00005). Despite the limitations imposed by a retrospective review of charts, our study provides an indication of the prevalence of blinding eye disease and distribution of visual acuity among ambulatory Jewish senior citizens in southern California. Except for the high prevalence of senile cataract, the prevalence data derived from this study are similar to other epidemiologic studies of eye disease in the elderly.

This study examined the prevalence of co-morbid age-related eye disease and symptoms of depression and anxiety in late life, and the relative roles of visual function and disease in explaining symptoms of depression and anxiety. A community-based sample of 662 individuals aged over 70 years was recruited through the electoral roll. Vision was measured using a battery of tests including high and low contrast visual acuity, contrast sensitivity, motion sensitivity, stereoacuity, Useful Field of View, and visual fields. Depression and anxiety symptoms were measured using the Goldberg scales. The prevalence of self-reported eye disease [cataract, glaucoma, or age-related macular degeneration (AMD)] in the sample was 43.4%, with 7.7% reporting more than one form of ocular pathology. Of those with no eye disease, 3.7% had clinically significant depressive symptoms. This rate was 6.7% among cataract patients, 4.3% among those with glaucoma, and 10.5% for AMD. Generalized linear models adjusting for demographics, general health, treatment, and disability examined self-reported eye disease and visual function as correlates of depression and anxiety. Depressive symptoms were associated with cataract only, AMD, comorbid eye diseases and reduced low contrast visual acuity. Anxiety was significantly associated with self-reported cataract, and reduced low contrast visual acuity, motion sensitivity and contrast sensitivity. We found no evidence for elevated rates of depressive or anxiety symptoms associated with self-reported glaucoma. The results support previous findings of high rates of depression and anxiety in cataract and AMD, and in addition show that mood and anxiety are associated with objective measures of visual function independently of self-reported eye disease. The findings have implications for the assessment and treatment of mental health in the context of late-life visual impairment.

Minoritized racial and ethnic groups, such as American Indian and Black individuals, often receive lower quality health care compared with White individuals. There is limited understanding of how these disparities extend to obstetric care, particularly when comparing the quality of care at the actual delivery hospital vs the nearest obstetric hospital based on the birthing individual's residence. To examine inequality in care based on the actual delivery hospital and the closest delivery hospital to the birthing individual's residential zip code centroid. This population-based retrospective cohort study used data from 5 states (2008 to 2020 for Michigan, Oregon, and South Carolina; 2008 to 2018 for Pennsylvania; and 2008 to 2012 for California). Individuals delivering a fetal death or a live birth with gestational age between 22 to 44 weeks were included. Analysis was conducted between February and August 2024. Race and ethnicity. The obstetric inequality index was calculated using Gini coefficients from Lorenz curves for American Indian, Asian, Black, and Hispanic birthing individuals compared with White individuals, with hospitals ranked by their standardized morbidity ratio for nontransfusion severe maternal morbidity. There were 6 418 635 birthing individuals across 549 hospitals (23 050 American Indian individuals [0.4%], 463 342 Asian individuals [7.2%], 807 738 Black individuals [12.6%], 1 645 922 Hispanic individuals [25.6%], and 3 279 315 White individuals [51.1%]). Compared with White individuals, American Indian and Black individuals delivered at lower-quality hospitals, while there was no significant difference for Asian and Hispanic individuals (delivery hospital inequality index: American Indian, 0.07 [95% CI, 0.03 to 0.11]; Asian, -0.02 [95% CI, -0.08 to 0.04]; Black, 0.15 [95% CI, 0.12 to 0.19]; Hispanic -0.04 [95% CI, -0.09 to 0.01]). Black individuals lived closer to lower-quality hospitals than White individuals (closest hospital inequality index for Black individuals: 0.11 [95% CI, 0.07 to 0.14]). Asian and Hispanic individuals had similar closest hospital inequality indices to White individuals. The inequality index for Black individuals would have been lower if individuals had delivered at their nearest hospital. This cohort study found that American Indian and Black individuals delivered at lower-quality hospitals than White individuals. The disparity in care between Black and White birthing individuals would have been reduced if individuals had delivered at their nearest hospital.

BACKGROUNDAmerican Indian individuals experience a relatively high risk for cardiovascular disease and have exhibited a higher risk of stroke compared with other racial and ethnic minorities. Although this population has the highest incidence of atrial fibrillation (AF) compared with other groups, the relationship between AF and nonhemorrhagic stroke among American Indian individuals compared with other groups has not been thoroughly studied.METHODS and RESULTSWe used the Healthcare Cost and Utilization Project to evaluate risk of nonhemorrhagic stroke among American Indian individuals, with comparisons to White, Black, Hispanic, and Asian individuals, among all adult California residents receiving care in an emergency department, inpatient hospital unit, or ambulatory surgery setting from 2005 to 2011. Of 16 951 579 patients followed for a median 4.1 years, 105 822 (0.6%) were American Indian. After adjusting for age, sex, income level, insurance payer, hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, cardiac surgery, valvular heart disease, chronic kidney disease, smoking, obstructive sleep apnea, pulmonary disease, and alcohol use, American Indian individuals with AF exhibited the highest risk of nonhemorrhagic stroke when compared with either non‐American Indian individuals with AF (hazard ratio, 1.38; 95% CI, 1.23–1.55; P<0.0001) or to each race and ethnicity with AF. American Indian individuals also experienced the highest overall risk for stroke, with no evidence that AF disproportionately heightened that risk in interaction analyses.CONCLUSIONSAmerican Indian individuals experienced the highest risk of nonhemorrhagic stroke, whether in the presence or absence of AF. Our findings likely suggest an opportunity to further study, if not immediately address, guideline‐adherent anticoagulation prescribing patterns among American Indian individuals with AF.

Bangladesh is densely populated country in South Asia, faces significant challenges in eye health due to various socioeconomic, environmental, and healthcare access factors. Limited access to quality eye care services, poor hygiene practices, prevalence of infectious diseases, and a high burden of non-communicable diseases contribute to the prevalence of eye disorders in the region. This study aims to comprehensively analyze the prevalence, distribution, and risk factors associated with various eye diseases among the population of Bangladesh. A systematic review and meta-analysis were conducted to gather data on the epidemiology of eye diseases in Bangladesh. Published studies, national surveys, and reports from relevant health organizations were reviewed to compile data on the prevalence, distribution, and risk factors of common eye conditions, including cataracts, refractive errors, conjunctivitis, glaucoma, diabetic retinopathy, and age-related macular degeneration. The prevalence of eye diseases in Bangladesh is relatively high, with conditions such as refractive errors, cataracts, glaucoma, and corneal diseases being major concerns. Refractive errors, including myopia, hyperopia, and astigmatism, affect a substantial portion of the population, particularly among children and young adults. Cataracts, a leading cause of blindness worldwide, also pose a significant burden in Bangladesh, with prevalence increasing with age. While the prevalence of glaucoma in Bangladesh is lower compared to some other countries, the condition remains a cause of concern due to its impact on quality of life and the healthcare system. Diabetic retinopathy, a complication of diabetes mellitus, affects the retina and is a leading cause of vision loss and blindness globally in the elderly. In Bangladesh, the rising prevalence of diabetes, fueled by changing lifestyles and an aging population, has contributed to an increasing burden of diabetic retinopathy. Conjunctivitis is prevalent, particularly in densely populated urban areas and rural communities with limited access to clean water and sanitation facilities.Collaborative efforts involving government agencies, healthcare providers, non-governmental organizations, and the community are essential to effectively address the burden of eye diseases in Bangladesh. By implementing preventive measures and improving access to quality eye care services, it is possible to mitigate the impact of these eye diseases and improve visual health outcomes for the population.

To describe dry eye disease in French elderly subjects. The Alienor Study is a population-based study on age-related eye disease in 963 residents of Bordeaux (France), aged 73 years or more. Self-reported dry eye disease and use of artificial tears were documented through face-to-face interview. Dry eye symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire and tear film stability by tear break-up time measurements (TBUT). Definite dry eye disease was defined as self-reported dry eye, confirmed by use of artificial tears and/or OSDI greater or equal to 22. Nine hundred and fifteen subjects, with mean age of 80 ± 4 years, returned the OSDI questionnaire. Of these, 271 (29.6%) subjects reported a dry eye disease and 135 (14.7%) were using artificial tears. An OSDI score > 22 was found in 359 (39.2%) subjects and a TBUT < 5 seconds in 335/746 (44.9%) subjects. Overall, definite dry eye affected 21.9% of subjects and was more frequent in women (27.1%) than in men (13.6%). After multivariate adjustment, dry eye disease was also significantly less frequent in subjects with high educational level (odds ratio (OR) = 0.49, 95% confidence interval (CI): 0.31-0.78 for long secondary school) and more frequent in subjects with ocular hypertension (OR = 1.61, 95% CI: 1.02-2.57) and those using anxiolytics (OR = 1.53, 95% CI: 1.02-2.29). This large observational study confirmed the high prevalence of dry eye symptoms among elderly subjects and confirmed some of the previously identified risk factors (in particular female gender and use of anxiolytics).

The priority problem of various industrial and developing countries, which largely determine the health of the population and, above all, older age groups, is currently eye diseases. Most modern researchers consider age-related macular degeneration, glaucoma, and cataracts to be eye diseases. Socially significant eye diseases have a high prevalence and are the leading cause of blindness in various countries. Authors analyzed the prevalence of glaucoma, age-related macular degeneration, and cataracts according to domestic and foreign publications in recent years. The results of the studies considered in the scientific review indicate a continuing gain in socially significant eye diseases, the frequency of which increases with age. The high incidence of the studied pathology is observed in China, India, and Russia. The study shows socially significant eye diseases to be the most critical problem in various countries, including the Russian Federation. The relevance of this pathology will increase due to the ongoing aging of the population and an increase in their share in the demographic structure of many states. The high prevalence of age-related macular degeneration, cataracts, and glaucoma leads to an increase in the number of people on the planet with complete or partial vision loss, which significantly disrupts their social functioning and requires significant financial costs for treatment and ensuring an acceptable level and quality of life. The data presented in the review and obtained results are of practical importance for the organization of monitoring of eye diseases and the development of an appropriate state and health strategy.

Objective: To assess the prevalence of eye diseases among elderly receiving care at a University Healthcare eye service. Materials and Methods: A retrospective review of medical records was conducted for elderly patients attending Rangsit University Healthcare’s eye services between 2020 and 2021. Data collected included age, gender, underlying systemic diseases, refraction data, and results of comprehensive eye examinations. Logistic regression analysis was performed to investigate the associations between age, gender, and eye diseases. Results: Out of 22,563 patients that attended the eye service, 1,452 were aged 60 years and older. The most common eye diseases observed were uncorrected refractive errors at 71.14%, followed by cataracts including pseudophakia at 69.77%, glaucoma at 21.9%, and posterior vitreous detachment at 14.6%. Additionally, pinguecula, pterygium, and lid disorders were presented in 10.67% of cases, dry eye 8.47%, retinal breaks 6.89%, epiretinal membrane 5.85%, diabetic retinopathy 4.75%, and age-related macular degeneration 4.13%. The prevalence of retinal breaks, epiretinal membrane, diabetic retinopathy, age-related macular degeneration, glaucoma, and corneal diseases increased with age while pinguecula, pterygium, and lid disorders showed an inverse association with age. Cataracts, posterior vitreous detachment, and dry eyes were more common in women, whereas, pinguecula, pterygium, lid disorders, and corneal diseases were more prevalent in men. Refractive error, glaucoma, and age-related macular degeneration showed no gender difference. Compared to the previous national surveys in Thailand, posterior segment eye diseases were more prevalent in the present study. Conclusion: Uncorrected refractive errors, cataracts, and glaucoma were the most prevalent eye diseases observed in the elderly patients, consistent with the previous national surveys. However, the present study identified an increased prevalence of posterior segment eye diseases. Early screening and referral by optometrists for timely treatment by ophthalmologists are crucial in preventing visual loss and achieving better visual outcomes while optimizing resource utilization.

Identifying gaps in inclusivity of Indigenous individuals is key to diversifying academic medical programs, increasing American Indian and Alaska Native representation, and improving disparate morbidity and mortality outcomes in American Indian and Alaska Native populations. To examine representation of American Indian and Alaska Native individuals at different stages in the 2018-2019 academic medical training continuum and trends (2011-2020) of American Indian and Alaska Native representation in residency specialties. A cross-sectional, population-based analysis was conducted using self-reported race and ethnicity data on trainees from the Association of American Medical Colleges (2018), the Accreditation Council for Graduate Medical Education (2011-2018), and the US Census (2018). Data were analyzed between February 18, 2020, and March 4, 2021. Enrolled trainees at specific stages of medical training. The primary outcome was the odds of representation of American Indian and Alaska Native individuals at successive academic medical stages in 2018-2019 compared with White individuals. Secondary outcomes comprised specialty-specific proportions of American Indian and Alaska Native residents from 2011 to 2020 and medical specialty-specific proportions of American Indian and Alaska Native physicians in 2018. Fisher exact tests were performed to calculate the odds of American Indian and Alaska Native representation at successive stages of medical training. Simple linear regressions were performed to assess trends across residency specialties. The study data contained a total of 238 974 607 White and American Indian and Alaska Native US citizens, 24 795 US medical school applicants, 11 242 US medical school acceptees, 10 822 US medical school matriculants, 10 917 US medical school graduates, 59 635 residents, 518 874 active physicians, and 113 168 US medical school faculty. American Indian and Alaska Native individuals had a 63% lower odds of applying to medical school (odds ratio [OR], 0.37; 95% CI, 0.31-0.45) and 48% lower odds of holding a full-time faculty position (OR, 0.52; 95% CI, 0.44-0.62) compared with their White counterparts, yet had 54% higher odds of working in a residency specialty deemed as a priority by the Indian Health Service (OR, 1.54; 95% CI, 1.09-2.16). Of the 33 physician specialties analyzed, family medicine (0.55%) and pain medicine (0.46%) had more than an average proportion (0.41%) of American Indian and Alaska Native physicians compared with their representation across all specialties. This cross-sectional study noted 2 distinct stages in medical training with significantly lower representation of American Indian and Alaska Native compared with White individuals. An actionable framework to guide academic medical institutions on their Indigenous diversification and inclusivity efforts is proposed.

Estimates of diabetic retinopathy (DR) incidence and progression in American Indian and Alaska Native individuals are based on data from before 1992 and may not be informative for strategizing resources and practice patterns. To examine incidence and progression of DR in American Indian and Alaska Native individuals. This was a retrospective cohort study conducted from January 1, 2015, to December 31, 2019, and included adults with diabetes and no evidence of DR or mild nonproliferative DR (NPDR) in 2015 who were reexamined at least 1 time during the 2016 to 2019 period. The study setting was the Indian Health Service (IHS) teleophthalmology program for diabetic eye disease. Development of new DR or worsening of mild NPDR in American Indian and Alaska Native individuals with diabetes. Outcomes were any increase in DR, 2 or more (2+) step increases, and overall change in DR severity. Patients were evaluated with nonmydriatic ultra-widefield imaging (UWFI) or nonmydriatic fundus photography (NMFP). Standard risk factors were included. The total cohort of 8374 individuals had a mean (SD) age of 53.2 (12.2) years and a mean (SD) hemoglobin A1c level of 8.3% (2.2%) in 2015, and 4775 were female (57.0%). Of patients with no DR in 2015, 18.0% (1280 of 7097) had mild NPDR or worse in 2016 to 2019, and 0.1% (10 of 7097) had PDR. The incidence rate from no DR to any DR was 69.6 cases per 1000 person-years at risk. A total of 6.2% of participants (441 of 7097) progressed from no DR to moderate NPDR or worse (ie, 2+ step increase; 24.0 cases per 1000 person-years at risk). Of patients with mild NPDR in 2015, 27.2% (347 of 1277) progressed to moderate NPDR or worse in 2016 to 2019, and 2.3% (30 of 1277) progressed to severe NPDR or worse (ie, 2+ step progression). Incidence and progression were associated with expected risk factors and evaluation with UWFI. In this cohort study, the estimates of DR incidence and progression were lower than those previously reported for American Indian and Alaska Native individuals. The results suggest extending the time between DR re-evaluations for certain patients in this population, if follow-up compliance and visual acuity outcomes are not jeopardized.

The National Cancer Database (NCDB) is an invaluable and widely used resource for cancer research, but the current state of representation of different racial and ethnic groups compared with the United States Cancer Statistics (USCS) database is unknown. To examine whether Hispanic and American Indian or Alaska Native individuals have lower representation in the NCDB compared with the USCS database. This multicenter, retrospective cohort study assessed individuals diagnosed with breast, colorectal, lung, and prostate cancer from January 1, 2004, to December 31, 2006, and January 1, 2017, to December 31, 2019, in the NCDB and USCS databases. Data analysis was performed from September 2022 to October 2023. Time. The primary outcome was the absolute percentage change (APC) in capture rate across the study period. The cohort included 5 175 007 individuals (0.50% American Indian or Alaska Native, 3.10% Asian or Pacific Islander, 12.01% Black, 6.58% Hispanic, and 77.81% White) who were diagnosed with breast, colorectal, lung, and prostate cancer. Capture rates were the lowest for individuals who were Hispanic (40.83% in 2004-2006 and 54.75% in 2017-2019; P < .001) or American Indian or Alaska Native (20.72% in 2004-2006 and 41.41% in 2017-2019; P < .001). The APCs were positive for both racial categories across all 4 cancers. However, overall APCs for Hispanic individuals (13.92%) remained lower than the overall APCs of White individuals (22.23%; P < .001). The APCs were greater for American Indian or Alaska Native individuals than for White individuals for prostate (14.68% vs 11.57%) and breast (21.61% vs 17.90%) cancer (P < .001), but the APCs for American Indian or Alaska Native individuals were lower than for White individuals for lung cancer (24.54% vs 33.03%; P < .001). In this cohort study of individuals diagnosed with cancer in the NCDB, Hispanic and American Indian or Alaska Native individuals diagnosed with breast, colorectal, lung, and prostate cancer were undercaptured in the NCDB, but their representation improved over time. Increased study is needed to determine where these populations predominantly seek cancer care.