Systemic Disease and Ocular Comorbidity Analysis of Geographically Isolated Federally Recognized American Indian Tribes of the Intermountain West
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 w...
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MDPI AG
2020-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/11/3590 |
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| author | Patrice M. Hicks Benjamin Haaland Michael Feehan Alan S. Crandall Jeff H. Pettey Elizabeth Nuttall William Self Mary Elizabeth Hartnett Paul Bernstein Albert Vitale Akbar Shakoor Julia P. Shulman Sandra F. Sieminski Ivana Kim Leah A. Owen Maureen A. Murtaugh Albert Noyes Margaret M. DeAngelis |
| author_facet | Patrice M. Hicks Benjamin Haaland Michael Feehan Alan S. Crandall Jeff H. Pettey Elizabeth Nuttall William Self Mary Elizabeth Hartnett Paul Bernstein Albert Vitale Akbar Shakoor Julia P. Shulman Sandra F. Sieminski Ivana Kim Leah A. Owen Maureen A. Murtaugh Albert Noyes Margaret M. DeAngelis |
| author_sort | Patrice M. Hicks |
| collection | DOAJ |
| description | 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 <i>p</i> < 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; <i>p</i> < 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 (<i>p</i> = 0.022), residing in the Four Corners (<i>p</i> = 0.027) and having hypertension (<i>p</i> < 0.001) increased the risk of DM. DM (<i>p</i> < 0.001) and age (<i>p</i> = 0.002) were significantly associated with hypertension in both populations examined. When retinopathy was evaluated for both populations combined, hypertension (<i>p</i> = 0.037) and living in Ibupah (<i>p</i> < 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 (<i>p</i> < 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. |
| first_indexed | 2024-03-10T15:01:55Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T15:01:55Z |
| publishDate | 2020-11-01 |
| publisher | MDPI AG |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-30a1964d9e4b4a5c98752c6d2603adab2023-11-20T20:05:47ZengMDPI AGJournal of Clinical Medicine2077-03832020-11-01911359010.3390/jcm9113590Systemic Disease and Ocular Comorbidity Analysis of Geographically Isolated Federally Recognized American Indian Tribes of the Intermountain WestPatrice M. Hicks0Benjamin Haaland1Michael Feehan2Alan S. Crandall3Jeff H. Pettey4Elizabeth Nuttall5William Self6Mary Elizabeth Hartnett7Paul Bernstein8Albert Vitale9Akbar Shakoor10Julia P. Shulman11Sandra F. Sieminski12Ivana Kim13Leah A. Owen14Maureen A. Murtaugh15Albert Noyes16Margaret M. DeAngelis17Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USADepartment of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USAKantar, LLC, New York, NY 10007, USADepartment of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USADepartment of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USADepartment of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USADepartment of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USADepartment of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USADepartment of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USADepartment of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USADepartment of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USADepartment of Ophthalmology, New York Medical College, Valhalla, NY 10595, USADepartment of Ophthalmology, Jacobs School of Medicine and Biomedical Engineering, University at Buffalo SUNY, and the VA Western New York Healthcare System, Buffalo, NY 14215, USARetina Service, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA 02114, USADepartment of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USADepartment of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USADepartment of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USADepartment of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 84132, USABackground: 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 <i>p</i> < 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; <i>p</i> < 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 (<i>p</i> = 0.022), residing in the Four Corners (<i>p</i> = 0.027) and having hypertension (<i>p</i> < 0.001) increased the risk of DM. DM (<i>p</i> < 0.001) and age (<i>p</i> = 0.002) were significantly associated with hypertension in both populations examined. When retinopathy was evaluated for both populations combined, hypertension (<i>p</i> = 0.037) and living in Ibupah (<i>p</i> < 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 (<i>p</i> < 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.https://www.mdpi.com/2077-0383/9/11/3590epidemiologyhypertensiondiabetesretinopathyAmerican Indianisolated populations |
| spellingShingle | Patrice M. Hicks Benjamin Haaland Michael Feehan Alan S. Crandall Jeff H. Pettey Elizabeth Nuttall William Self Mary Elizabeth Hartnett Paul Bernstein Albert Vitale Akbar Shakoor Julia P. Shulman Sandra F. Sieminski Ivana Kim Leah A. Owen Maureen A. Murtaugh Albert Noyes Margaret M. DeAngelis Systemic Disease and Ocular Comorbidity Analysis of Geographically Isolated Federally Recognized American Indian Tribes of the Intermountain West Journal of Clinical Medicine epidemiology hypertension diabetes retinopathy American Indian isolated populations |
| title | Systemic Disease and Ocular Comorbidity Analysis of Geographically Isolated Federally Recognized American Indian Tribes of the Intermountain West |
| title_full | Systemic Disease and Ocular Comorbidity Analysis of Geographically Isolated Federally Recognized American Indian Tribes of the Intermountain West |
| title_fullStr | Systemic Disease and Ocular Comorbidity Analysis of Geographically Isolated Federally Recognized American Indian Tribes of the Intermountain West |
| title_full_unstemmed | Systemic Disease and Ocular Comorbidity Analysis of Geographically Isolated Federally Recognized American Indian Tribes of the Intermountain West |
| title_short | Systemic Disease and Ocular Comorbidity Analysis of Geographically Isolated Federally Recognized American Indian Tribes of the Intermountain West |
| title_sort | systemic disease and ocular comorbidity analysis of geographically isolated federally recognized american indian tribes of the intermountain west |
| topic | epidemiology hypertension diabetes retinopathy American Indian isolated populations |
| url | https://www.mdpi.com/2077-0383/9/11/3590 |
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