American Journal of Epidemiology Vol. 147, No. 5: 448-457
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health
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Prevalence and Risk Factors for Diabetic Retinopathy in the Multiethnic Population of Mauritius
G. K. Dowse and A. R. G. Humphrey are joint first authors
1Public Health Division, Health Department Perth, Western Australia
2Redbridge and Waltham Forest Health Authority Essex, United Kingdom
3International Diabetes Institute Melbourne, Australia
4Ministry of Health Port Louis, Mauritius
5Department of Ophthamology, University of Melbourne Melbourne, Australia
6Diabetes and Genetic Epidemiology Unit, National Public Health Institute Helsinki, Finland
7Human Diabetes and Metabolism Research Centre, University of Newcastle Upon Tyne Newcastle Upon Tyne, united Kingdom
This study examines the prevalence of, and risk factors for, diabetic retinopathy in Asian Indian, Chinese, and Creole Mauritians in whom there is an increasing prevalence of non-insulin-dependent diabetes mellitus (NIDDM). As part of a population-based survey on the Indian Ocean Island of Mauritius in 1992, glucose tolerance was classified using a 75-g oral glucose tolerance test on 6,553 persons. Subjects with newly diagnosed (n = 358) or known diabetes (n = 388), and a random sample of one in four subjects with imparied glucose tolerance (n = 165), had stereoscopic 45° retinal photographs taken of three fields in the right eye after mydriasis. Photographs were graded according to a modified version of the Airlie House criteria. The prevalence of nonproliferative and proliferative retinopathy was: 14.5% and 0.3%, respectively, in newly diagnosed diabetic subjects; 42.0% and 2.3%, respectively, in known diabetic subjects; and 9.1% and 0% respectively, in persons with impaired glucose tolerance. Muslim Indians had the lowest prevalence of retinopathy (10.8% and 34.0% for new and known diabetes, respectively), Univariate analysis revealed significant differences between diabetic with and withour retinopathy in mean age, body mass index, fasting and 2-hour plasma glucose levels, systolic and diastolic blood pressure, fasting triglycerides, serum creatinine, and urinary albumin levels. For known diabetes, mean duration of diabetes and the proportion using insulin were also greater in those with retinopathy. Multivariate analysis using logistic regression confirmed that increasing duration of diabetes, fasting plasma glucose, systolic blood pressure, and urinary albumin concentration, and decreasing body mass index, were independently associated with retinopathy. The high prevalence of diabetic retinopathy observed in all major ethnic groups in Mauritius portends a serious public health problem, given the relative recency of the NIDDM epidemic in that country and the limited resources for laser photocoagulation. Strategies to minimize this problem among those already known to have diabetes should include strict control of plasma glucose and blood pressure. Am J Epidemiol 1998; 147:448–57.
diabetes mellitus; non-insulin-dependent; diabetic retinopathy; ethnic groups; prevalence; risk factors
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