Dataset Information

No ethnic differences in the association of glycated hemoglobin with retinopathy: the national health and nutrition examination survey 2005-2008.

ABSTRACT:

Objective

Current recommendations for the use of hemoglobin A(1c) (HbA(1c)) in diabetes screening and diagnosis aim to identify those at greatest risk for diabetic microvascular complications. However, there is current controversy regarding the clinical implications of ethnic differences in HbA(1c) values. The objective of this study was to determine whether the association between HbA(1c) and retinopathy differs by ethnic group in a representative sample of U.S. adults.

Research design and methods

The study was a cross-sectional analysis of 2,945 non-Hispanic white, 1,046 non-Hispanic black, and 1,231 Hispanic American participants aged ?40 years from the 2005-2008 National Health and Nutrition Examination Survey.

Results

Among nondiabetic adults, the mean HbA(1c) was 5.5% in non-Hispanic whites, 5.7% in non-Hispanic blacks, and 5.6% in Hispanic Americans. Among those with diagnosed diabetes, mean HbA(1c) was 6.9% in non-Hispanic whites, 7.5% in non-Hispanic Blacks, and 7.7% in Hispanic Americans. Overall, non-Hispanic blacks had the highest prevalence of retinopathy. In multivariable logistic models, HbA(1c) clinical categories were strongly associated with prevalent retinopathy. However, the magnitude of the association did not differ by ethnic group (all P values for interaction ? 0.7). Similar results were observed with HbA(1c) modeled continuously (per one percentage point) and stratified by diabetes status (all P for interactions > 0.3).

Conclusions

We observed no ethnic differences in the association of HbA(1c) with retinopathy. These data do not support ethnic-specific cut points for HbA(1c) for diagnosis or screening of diabetes mellitus.

SUBMITTER: Bower JK

PROVIDER: S-EPMC3579340 | biostudies-literature | 2013 Mar

REPOSITORIES: biostudies-literature

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Publications

No ethnic differences in the association of glycated hemoglobin with retinopathy: the national health and nutrition examination survey 2005-2008.

Bower Julie K JK Brancati Frederick L FL Selvin Elizabeth E

Diabetes care 20121015 3

<h4>Objective</h4>Current recommendations for the use of hemoglobin A(1c) (HbA(1c)) in diabetes screening and diagnosis aim to identify those at greatest risk for diabetic microvascular complications. However, there is current controversy regarding the clinical implications of ethnic differences in HbA(1c) values. The objective of this study was to determine whether the association between HbA(1c) and retinopathy differs by ethnic group in a representative sample of U.S. adults.<h4>Research desi ...[more]

PMID: 23069841

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Project description:ObjectiveThis study aimed to elucidate the relationship between retinopathy status or severity and the all-cause and specific-cause mortality risk based on the updated National Health and Nutrition Examination Survey (NHANES) database and 2019 Public Access Link mortality file.MethodsIn this prospective cohort study, a total of 6,797 participants aged over 40 years based on NHANES 2005-2008 were analyzed. The severity of retinopathy was classified into 4 grades-no retinopathy, mild non-proliferative retinopathy (NPR), moderate to severe NPR, and proliferative retinopathy (PR). Multiple covariate-adjusted Cox proportional hazards regression models and Fine and Gray competing risk regression models were used to assess the all-cause and cause-specific mortality risks, respectively. The propensity score matching (PSM) approach was also applied additionally to adequately balance between-group covariates to validate our findings.ResultsA final total of 4,808 participants representing 18,282,772 United States (US) non-hospitalized participants were included for analysis, 50.27% were male (n = 2,417), 55.32% were non-hispanic white (n = 2,660), and mean [SE] age, 56.10 [0.40] years. After a median follow-up of 12.24 years (interquartile range, 11.16-13.49 years), 1,164 participants died of all-cause mortality, of which 941 (80.84%) died without retinopathy and 223 (19.16%) died with retinopathy at baseline. The presence of retinopathy was associated with increased all-cause mortality, cardiovascular disease (CVD), and diabetes mellitus (DM)-specific mortality, and the results remain consistent after PSM. Severity analysis showed that only mild NPR was associated with an increased all-cause mortality risk (hazard ratio (HR) = 2.01; 95% confidence interval (CI), 1.00-4.03), while increased CVD and DM-specific mortality risk were associated with all grades of retinopathy and were exponentially greater with increasing retinopathy severity, and the trend test was also significant (P for trend 0.004 and 0.04, respectively).DiscussionOur findings suggest that the diagnosis of retinopathy is an independent risk factor for all-cause mortality in people over 40 years old. Retinopathy grading is significantly associated with the survival risk of patients with CVD or DM, it can be a valuable predictor in the stratified management and risk warning of CVD or DM patients, as well as in the monitoring of systemic vasculopathy status.

Project description:BackgroundAlcohol consumption and its interaction with disease, medication use, and functional status may result in serious health problems, but little information exists about the national prevalence of alcohol-related health risk in older adults.ObjectiveTo estimate the prevalence of harmful and hazardous alcohol use and the prevalence of consumption in excess of National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommendations, in people aged 65 and older, and by sex and race/ethnicity sub-group.DesignCross-sectional, using data from the 2005-2008 National Health and Nutrition Examination Survey of the non-institutionalized U.S. population.ParticipantsOne thousand and eighty-three respondents aged 65 and older who consume alcohol.Main measuresParticipants' alcohol consumption was classified as Harmful, Hazardous, or Healthwise, in the context of their specific health status, using the Alcohol-Related Problems Survey classification algorithm.Key resultsOverall, 14.5 % of older drinkers (95 % CI: 12.1 %, 16.8 %) consumed alcohol above the NIAAA's recommended limits. However, when health status was taken into account, 37.4 % of older drinkers (95 % CI: 34.9 %, 40.0 %) had Harmful consumption and 53.3 % (95 % CI: 50.1 %, 56.6 %) had either Hazardous or Harmful consumption. Among light/moderate drinkers, the proportions were 17.7 % (95 % CI: 14.7 %, 20.7 %) and 28.0 % (95 % CI: 24.8 %, 31.1 %), respectively. Male drinkers had significantly greater odds of Hazardous/Harmful consumption than female drinkers (OR?=?2.14 [95 % CI: 1.77, 2.6]). Black drinkers had worse health status and significantly greater odds of Hazardous/Harmful consumption than white drinkers (OR?=?1.49; 95 % CI: 1.02, 2.17), despite having no greater prevalence of drinking in excess of NIAAA-recommended limits.ConclusionMost older Americans who drink are light/moderate drinkers, yet substantial proportions of such drinkers drink in a manner that is either harmful or hazardous to their health. Older adults with risky alcohol consumption are unlikely to be identified by health care providers if clinicians rely solely on whether patient consumption exceeds the NIAAA-recommended limits.

Dataset Information

No ethnic differences in the association of glycated hemoglobin with retinopathy: the national health and nutrition examination survey 2005-2008.

Objective

Research design and methods

Results

Conclusions

Publications

No ethnic differences in the association of glycated hemoglobin with retinopathy: the national health and nutrition examination survey 2005-2008.

Similar Datasets

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