Prevalence of Diabetic Eye Diseases in American Indians and Alaska Natives (AI/AN) as Identified by the Indian Health Service’s National Teleophthalmology Program Using Ultrawide Field Imaging (UWFI)

Figures & data

Figure 1. Locations of the IHS teleophthalmology program sites (n = 78) for this analysis within the IHS administrative areas.

Table 1. Background characteristics of analytic sample (n = 53,900).

Measure	n	Percent or Mean	95% CI
Years of age, mean	53900	55.8 (13.4)	55.7, 55.9
Male, percent	24432	45.3	44.9, 45.8
IHS area or region, percent
Alaska	186	0.4	0.3, 0.4
Nashville	2355	4.4	4.2, 4.5
Northcentral/Great Plains	8391	15.6	15.3, 15.9
Northwest/Portland	1461	2.7	2.6, 2.9
Oklahoma	13369	24.8	24.4, 25.2
Southwest	28138	52.2	51.8, 52.6
Diabetes duration, percent
Less than 1 year	4830	9.0	8.7, 9.2
1 to 5 years	12448	23.1	22.7, 23.5
6 to 10 years	10616	19.7	19.4, 20.0
More than 10 years	19074	35.4	35.0, 35.8
Not specified	6932	12.9	12.6, 13.1
A1c, mmol/mol, mean	47865	68 (25)	68.2, 68.6
No recent A1c, percent	6035	11.2	10.9, 11.5
Diabetes therapy, percent
Diet only	3779	7.0	6.8, 7.2
Oral medications only	25969	48.2	47.8, 48.6
Insulin only	5843	10.8	10.6, 11.1
Oral medications & insulin	12218	22.7	22.3, 23.0
Not specified	6091	11.3	11.0, 11.6
Risk factors, percent
Hypercholesterolemia present	19126	35.5	35.1, 35.9
Anemia present	1630	3.0	2.9, 3.2
Cardiovascular disease present	5032	9.3	9.1, 9.6
Hypertension present	31110	57.7	57.3, 58.1
Peripheral neuropathy present	2649	4.9	4.7, 5.1
Nephropathy present	2067	3.8	3.7, 4.0

Notes:

IHS = Indian Health Service.

CI = confidence interval.

Table includes all patients irrespective of whether their images were gradable.

Standard deviations are shown in parentheses after the means for age and A1c.

95% CI was calculated assuming a normal distribution and z score of 1.96.

Table 2. Crude prevalence of diabetic eye disease.

Measure	n	Percent	95% CI
Any DR (n = 51,415)	14717	28.6	28.2, 29.0
DR severity (n = 51,415)
Absent	36698	71.4	71.0, 71.8
Mild NPDR	6342	12.3	12.1, 12.6
Moderate NPDR	6893	13.4	13.1, 13.7
Severe or Very Severe NPDR	46	0.1	0.1, 0.1
PDR	1436	2.8	2.7, 2.9
Any DME (n = 50,970)	1525	3.0	2.8, 3.1
DME severity (n = 50,970)
Absent	49445	97.0	96.9, 97.2
Present, not CSDME	1207	2.4	2.2, 2.5
Present and CSDME	318	0.6	0.6, 0.7
Sight-threatening disease (n = 50,387)	1525	3.0	2.9, 3.2

Notes:

CI = confidence interval.

DR = diabetic retinopathy.

NPDR = nonproliferative diabetic retinopathy.

PDR = proliferative diabetic retinopathy.

DME = diabetic macular edema.

CSDME = clinically significant diabetic macular edema.

Percentages for diabetic eye disease are of total gradable studies; 2,485 were

ungradable for DR, 2,930 were ungradable for DME, 3,513 were ungrable for both DR and DME.

95% CI was calculated assuming a normal distribution and z score of 1.96.

Table 3. Adjusted prevalence of DR and DME, by region, gender and age.

Region	Gender	Age (years)	Any DR	DR Absent	Mild NPDR	Moderate NPDR	Severe/Very Severe NPDR	PDR	Any DME	DME Absent	Present, not CSDME	Present and CSDME
Alaska	Male	< 50	22.5	77.8	10.1	10.1	0.1	2.0	2.0	98.0	1.6	0.4
		50–59	24.8	76.4	10.6	10.8	0.1	2.2	1.8	98.3	1.4	0.4
		60–69	26.1	75.7	10.9	11.2	0.1	2.2	1.7	98.4	1.3	0.3
		70–79	27.4	75.0	11.1	11.5	0.1	2.3	1.6	98.5	1.2	0.3
		80+	28.7	74.2	11.4	11.9	0.1	2.4	1.5	98.6	1.2	0.3
	Female	< 50	20.2	80.2	9.1	8.9	0.1	1.7	1.8	98.2	1.4	0.4
		50–59	22.4	78.9	9.6	9.5	0.1	1.9	1.6	98.4	1.3	0.3
		60–69	23.6	78.3	9.9	9.8	0.1	1.9	1.5	98.5	1.2	0.3
		70–79	24.8	77.6	10.2	10.2	0.1	2.0	1.4	98.6	1.1	0.3
		80+	26.0	76.9	10.4	10.5	0.1	2.1	1.3	98.7	1.1	0.3
Nashville	Male	< 50	31.4	66.9	13.8	15.8	0.1	3.4	4.6	95.5	3.6	1.0
		50–59	34.3	65.1	14.3	16.8	0.1	3.7	4.0	96.0	3.2	0.9
		60–69	35.8	64.2	14.5	17.3	0.1	3.8	3.8	96.2	3.0	0.8
		70–79	37.3	63.3	14.8	17.8	0.1	4.0	3.6	96.4	2.8	0.8
		80+	38.9	62.4	15.0	18.4	0.1	4.1	3.4	96.6	2.7	0.7
	Female	< 50	25.8	70.1	12.8	14.1	0.1	3.0	4.2	95.8	3.3	0.9
		50–59	31.3	68.4	13.3	15.0	0.1	3.2	3.7	96.3	3.0	0.8
		60–69	32.7	67.5	13.6	15.5	0.1	3.3	3.5	96.5	2.8	0.7
		70–79	34.2	66.6	13.9	16.0	0.1	3.5	3.3	96.7	2.6	0.7
		80+	35.7	65.7	14.1	16.5	0.1	3.6	3.1	96.9	2.5	0.7
Northcentral/Great Plains	Male	< 50	28.9	70.0	12.8	14.1	0.1	3.0	3.8	96.2	3.0	0.8
		50–59	31.7	68.3	13.4	15.1	0.1	3.2	3.4	96.7	2.7	0.7
		60–69	33.1	67.4	13.6	15.5	0.1	3.3	3.2	96.9	2.5	0.7
		70–79	34.6	66.5	13.9	16.0	0.1	3.5	3.0	97.0	2.4	0.6
		80+	36.1	65.6	14.2	16.5	0.1	3.6	2.8	97.2	2.2	0.6
	Female	< 50	26.2	73.0	11.8	12.6	0.1	2.6	3.5	96.5	2.8	0.7
		50–59	28.8	71.4	12.4	13.4	0.1	2.8	3.1	96.9	2.5	0.7
		60–69	30.2	70.5	12.7	13.8	0.1	2.9	2.9	97.1	2.3	0.6
		70–79	31.6	69.7	12.9	14.3	0.1	3.0	2.7	97.3	2.2	0.6
		80+	33.1	68.9	13.2	14.7	0.1	3.1	2.6	97.4	2.1	0.5
Northwest /Portland	Male	< 50	24.0	75.0	11.1	11.5	0.1	2.3	2.9	97.1	2.3	0.6
		50–59	26.5	73.4	11.7	12.3	0.1	2.5	2.6	97.4	2.0	0.5
		60–69	27.8	72.7	11.9	12.7	0.1	2.6	2.4	97.6	1.9	0.5
		70–79	29.2	71.9	12.2	13.1	0.1	2.7	2.3	97.7	1.8	0.5
		80+	30.5	71.1	12.5	13.6	0.1	2.8	2.1	97.9	1.7	0.4
	Female	< 50	21.6	77.6	10.1	10.2	0.1	2.0	2.7	97.3	2.1	0.6
		50–59	23.9	76.2	10.7	10.9	0.1	2.2	2.4	97.6	1.9	0.5
		60–69	25.2	75.5	10.9	11.3	0.1	2.3	2.2	97.8	1.8	0.5
		70–79	26.4	74.7	11.2	11.7	0.1	2.4	2.1	97.9	1.7	0.4
		80+	27.7	74.0	11.5	12.0	0.1	2.5	2.0	98.0	1.6	0.4
Oklahoma	Male	< 50	24.4	75.1	11.1	11.5	0.1	2.3	2.8	97.2	2.2	0.6
		50–59	26.9	73.6	11.6	12.2	0.1	2.5	2.5	97.5	2.0	0.5
		60–69	28.3	72.8	11.9	12.6	0.1	2.6	2.4	97.6	1.9	0.5
		70–79	29.6	72.0	12.2	13.1	0.1	2.7	2.2	97.8	1.8	0.5
		80+	31.0	71.2	12.4	13.5	0.1	2.8	2.1	97.9	1.7	0.4
	Female	< 50	22.0	77.7	10.1	10.1	0.1	2.0	2.6	97.4	2.1	0.5
		50–59	24.4	76.3	10.6	10.8	0.1	2.2	2.3	97.7	1.8	0.5
		60–69	25.6	75.6	10.9	11.2	0.1	2.3	2.2	97.8	1.7	0.5
		70–79	26.9	74.8	11.2	11.6	0.1	2.3	2.0	98.0	1.6	0.4
		80+	28.2	74.1	11.4	12.0	0.1	2.4	1.9	98.1	1.5	0.4
Southwest	Male	< 50	28.2	70.2	12.8	14.0	0.1	2.9	3.7	96.3	2.9	0.8
		50–59	31.0	68.5	13.3	14.9	0.1	3.2	3.3	96.7	2.6	0.7
		60–69	32.4	67.7	13.6	15.4	0.1	3.3	3.1	96.9	2.5	0.7
		70–79	33.9	66.8	13.8	15.9	0.1	3.4	2.9	97.1	2.3	0.6
		80+	35.4	65.9	14.1	16.4	0.1	3.6	2.8	97.2	2.2	0.6
	Female	< 50	25.5	73.2	11.8	12.4	0.1	2.5	3.5	96.6	2.7	0.7
		50–59	28.1	71.6	12.3	13.3	0.1	2.8	3.1	97.0	2.4	0.6
		60–69	29.5	70.8	12.6	13.7	0.1	2.9	2.9	97.1	2.3	0.6
		70–79	30.9	69.9	12.8	14.2	0.1	3.0	2.7	97.3	2.1	0.6
		80+	32.3	69.1	13.1	14.6	0.1	3.1	2.5	97.5	2.0	0.5

Notes:

DR = diabetic retinopathy.

NPDR = nonproliferative diabetic retinopathy.

PDR = proliferative diabetic retinopathy.

DME = diabetic macular edema.

CSDME = clinically significant diabetic macular edema.

The modeled stratum-specific estimates used the midpoint for each age group in the equations (e.g., 35, 55, etc.).

Adjusting the prevalence estimates for age, gender, and region means ‘any’ DR and ‘any’ DME are not equal to summing the

adjusted estimates for levels of DR and DME.