Asian American/Pacific Islander paradox in diabetic retinopathy: findings from the Behavioral Risk Factor Surveillance System, 2006-2008.

OBJECTIVES To compare the self-reported prevalence of diabetic retinopathy (DR) between Asian Americans/Pacific Islanders (AAPIs) and Whites in the United States. METHODS We analyzed data from 70,209 adults aged > or =18 years with diabetes derived from the 2006-2008 Behavioral Risk Factor Surveillance System (BRFSS), including 1,499 AAPIs and 68,710 White individuals. RESULTS Compared with Whites with diabetes, AAPIs with diabetes had higher socioeconomic status, fewer risk factors (eg, smoking) and coexisting chronic diseases (eg, cardiovascular disease [CVD]). Diabetes duration and percentage of persons using insulin were similar between the 2 populations. However, AAPIs had a much higher prevalence of DR (27.6%) than Whites (18.2%) (P<.001). Comparing AAPIs to Whites, the age- and gender-adjusted odds ratio of DR was 1.97 (1.48-2.62). The adjusted odds ratio was 2.21 (1.63-3.00) after adjustment for sociodemographic (education and marital status), chronic conditions (CVD and smoking), severity of diabetes and diabetes care (age of diabetes onset, frequency of self-checking blood sugar, and frequency of dilated eye exam). CONCLUSIONS Despite their favorable socio- and health-related profiles, AAPIs had significantly higher prevalence of DR compared with Whites.