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      Systemic Disease and Ocular Comorbidity Analysis of Geographically Isolated Federally Recognized American Indian Tribes of the Intermountain West

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          Background: The American Indian Navajo and Goshute peoples are underserved patient populations residing in the Four Corners area of the United States and Ibupah, Utah, respectively. Methods: We conducted a cross-sectional study of epidemiological factors and lipid biomarkers that may be associated with type II diabetes, hypertension and retinal manifestations in tribal and non-tribal members in the study areas (n = 146 participants). We performed multivariate analyses to determine which, if any, risk factors were unique at the tribal level. Fundus photos and epidemiological data through standardized questionnaires were collected. Blood samples were collected to analyze lipid biomarkers. Univariate analyses were conducted and statistically significant factors at p < 0.10 were entered into a multivariate regression. Results: Of 51 participants for whom phenotyping was available, from the Four Corners region, 31 had type II diabetes (DM), 26 had hypertension and 6 had diabetic retinopathy (DR). Of the 64 participants from Ibupah with phenotyping available, 20 had diabetes, 19 had hypertension and 6 had DR. Navajo participants were less likely to have any type of retinopathy as compared to Goshute participants (odds ratio (OR) = 0.059; 95% confidence interval (CI) = 0.016–0.223; p < 0.001). Associations were found between diabetes and hypertension in both populations. Older age was associated with hypertension in the Four Corners, and the Navajo that reside there on the reservation, but not within the Goshute and Ibupah populations. Combining both the Ibupah, Utah and Four Corners study populations, being American Indian ( p = 0.022), residing in the Four Corners ( p = 0.027) and having hypertension ( p < 0.001) increased the risk of DM. DM ( p < 0.001) and age ( p = 0.002) were significantly associated with hypertension in both populations examined. When retinopathy was evaluated for both populations combined, hypertension ( p = 0.037) and living in Ibupah ( p < 0.001) were associated with greater risk of retinopathy. When combining both American Indian populations from the Four Corners and Ibupah, those with hypertension were more likely to have DM ( p < 0.001). No lipid biomarkers were found to be significantly associated with any disease state. Conclusions: We found different comorbid factors with retinal disease outcome between the two tribes that reside within the Intermountain West. This is indicated by the association of tribe and with the type of retinopathy outcome when we combined the populations of American Indians. Overall, the Navajo peoples and the Four Corners had a higher prevalence of chronic disease that included diabetes and hypertension than the Goshutes and Ibupah. To the best of our knowledge, this is the first study to conduct an analysis for disease outcomes exclusively including the Navajo and Goshute tribe of the Intermountain West.

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          Type 2 diabetes is now a pandemic and shows no signs of abatement. In this Seminar we review the pathophysiology of this disorder, with particular attention to epidemiology, genetics, epigenetics, and molecular cell biology. Evidence is emerging that a substantial part of diabetes susceptibility is acquired early in life, probably owing to fetal or neonatal programming via epigenetic phenomena. Maternal and early childhood health might, therefore, be crucial to the development of effective prevention strategies. Diabetes develops because of inadequate islet β-cell and adipose-tissue responses to chronic fuel excess, which results in so-called nutrient spillover, insulin resistance, and metabolic stress. The latter damages multiple organs. Insulin resistance, while forcing β cells to work harder, might also have an important defensive role against nutrient-related toxic effects in tissues such as the heart. Reversal of overnutrition, healing of the β cells, and lessening of adipose tissue defects should be treatment priorities. Copyright © 2011 Elsevier Ltd. All rights reserved.
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              The Strong Heart Study. A study of cardiovascular disease in American Indians: design and methods.

              Available data indicate that cardiovascular disease has become the leading cause of death in American Indians. However, limited information is available on cardiovascular disease incidence, prevalence, and risk factors in this population. Reported cardiovascular disease rates vary greatly among groups in different geographic areas. These rates have been obtained from studies of varying sizes and different methodologies. The Strong Heart Study, which uses standardized methodology, is designed to estimate cardiovascular disease mortality and morbidity rates and the prevalence of known and suspected cardiovascular disease risk factors in American Indians. The study population consists of 12 tribes in three geographic areas: an area near Phoenix, Arizona, the southwestern area of Oklahoma, and the Aberdeen area of North and South Dakota. The study includes three components. The first is a mortality survey to estimate cardiovascular disease mortality rates for 1984-1988 among tribal members aged 35-74 years, and the second is a morbidity survey to estimate incidence of both first and first or recurrent hospitalized myocardial infarction and stroke (cerebrovascular disease) among tribal members aged 45-74 years in 1984-1988, and the third is a clinical examination of 4,500 tribal members aged 45-74 years in order to estimate the prevalence of cardiovascular disease and its associations with risk factors. Family history, diet, alcohol and tobacco consumption, physical activity, degree of acculturation, and socioeconomic status are assessed in personal interviews. The physical examination includes measurements of body fat, body circumferences, and blood pressure, an examination of the heart and lungs, an evaluation of peripheral vascular disease, and a 12-lead electrocardiogram. Laboratory measurements include fasting and postload glucose, insulin, fasting lipids, apoproteins, fibrinogen, and glycated hemoglobin. Also measured are serum and urine creatinine and urinary albumin. DNA from lymphocytes is isolated and stored for future genetic studies.

                Author and article information

                J Clin Med
                J Clin Med
                Journal of Clinical Medicine
                07 November 2020
                November 2020
                : 9
                : 11
                [1 ]Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USA; patrice.hicks@ 123456hsc.utah.edu (P.M.H.); alan.crandall@ 123456hsc.utah.edu (A.S.C.); jeff.pettey@ 123456hsc.utah.edu (J.H.P.); elizabeth.nuttall@ 123456hsc.utah.edu (E.N.); wjself@ 123456moffatfarm.com (W.S.); me.hartnett@ 123456hsc.utah.edu (M.E.H.); paul.bernstein@ 123456hsc.utah.edu (P.B.); albert.vitale@ 123456hsc.utah.edu (A.V.); akbar.shakoor@ 123456hsc.utah.edu (A.S.); Leah.Owen@ 123456hsc.utah.edu (L.A.O.); albert.noyes@ 123456mosaicmedical.org (A.N.)
                [2 ]Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USA; Ben.Haaland@ 123456hsc.utah.edu (B.H.); maureen.murtaugh@ 123456hsc.utah.edu (M.A.M.)
                [3 ]Kantar, LLC, New York, NY 10007, USA; michael.Feehan@ 123456kantar.com
                [4 ]Department of Ophthalmology, New York Medical College, Valhalla, NY 10595, USA; jshulman03@ 123456gmail.com
                [5 ]Department of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, University at Buffalo SUNY, and the VA Western New York Healthcare System, Buffalo, NY 14215, USA; sandrafe@ 123456buffalo.edu
                [6 ]Retina Service, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA 02114, USA; ivana_kim@ 123456meei.harvard.edu
                Author notes
                [* ]Correspondence: mmdeange@ 123456buffalo.edu ; Tel.: +1-(716)-834-9200 (ext. 2657)
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).



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