Moderate-to-Severe Diabetic Retinopathy Is More Prevalent in Mexico City Than in San Antonio, Texas
- Maria Elena González Villalpando, MD,
- Clicerio González Villalpando, MD,
- Beatriz Arredondo Pérez, MD,
- Sandra Virginia Martínez Díaz, BS,
- Braxton Mitchell, PHD,
- David Rivera Martínez, RDMS,
- Ronald Klein, MD, MPH,
- Steven M Haffner, MD, MPH and
- Michael P Stern, MD
- Centro de Estudios en Diabetes, Department of Internal Medicine, University of Texas Health Science Center San Antonio, Texas
- Unidad de Investigacion Medica en Enfermedades Metabólicas Hospital de Especialidades “Dr. Bernardo Sepulveda”, Department of Internal Medicine, University of Texas Health Science Center San Antonio, Texas
- Centra Médico Nacional Siglo XXI, Instituto Mexicano del Seguro SocialMexico City, Mexico Department of Ophthalmology and Visual Sciences, Department of Internal Medicine, University of Texas Health Science Center San Antonio, Texas
- University of Wisconsin Madison, Wisconsin Division of Clinical Epidemiology, Department of Internal Medicine, University of Texas Health Science Center San Antonio, Texas
- Address correspondence and reprint requests to Clicerio González Villalpando, FACP, Centra de Estudios en Diabetes, Apdo. Postal México 7–1085, México 06700 D.F.E-mail: cgonzala{at}buzon.main.conacyt.mx
Abstract
OBJECTIVE To compare the prevalence of diabetic retinopathy (DR) between low-income Mexicans from Mexico City and Mexican-Americans from San Antonio, Texas.
RESEARCH DESIGN AND METHODS We designed a cross-sectional population-based study in low-income neighborhoods of Mexico City and San Antonio. The men and non-pregnant women included in the study had NIDDM and were between 35 and 64 years of age. Ophthalmologic evaluation was performed in 414 patients, 204 in San Antonio and 210 in Mexico City. Seven field standard stereophotographs of each eye were obtained, adapting the Early Treatment Diabetic Retinopathy Study protocol, and graded at the Fundus Photograph Reading Center of the University of Wisconsin.
RESULTS Early nonproliferative DR occurred in 37 (17.6%) and 39 (19.1%) patients in Mexico City and San Antonio, respectively. Moderate-to-severe nonproliferative DR occurred in 55 (26.2%) and 37 (18.1%) patients in Mexico City and San Antonio, respectively, and proliferative DR occurred in 12 (5.7%) and 7 (3.4%) patients in Mexico City and San Antonio, respectively. Using univariate and multivariate logistic regression analysis with DR as the dependent variable, age, duration of disease, and fasting glucose concentration were positively and significantly associated with retinopathy, whereas city, systolic blood pressure, and other selected metabolic variables were not. We defined moderate-to-severe DR to include the categories of moderate-to-severe nonproliferative and proliferative DR. For this combined category, Mexico City patients with diabetes had a significantly higher prevalence (P < 0.01) than those from San Antonio when analyzed by multiple logistic regression analysis (odds ratio for Mexico City/San Antonio, 1.72; 95% CI 1.10–2.70).
CONCLUSIONS Overall prevalence of DR is similar in both cities. However, moderate-to-severe DR is significantly higher in Mexico City.
- Copyright © 1997 by the American Diabetes Association
