Presence of diabetic retinopathy is associated with worse 10-year mortality among Indigenous Australians in Central Australia: The Central Australian ocular health study

Importance:

Diabetes mellitus (DM) is highly prevalent among Indigenous Australians and contributes greatly to premature death. The association of diabetic retinopathy (DR) with early mortality, however, has not previously been reported among Indigenous Australians.

Background:

To investigate associations between 10-y mortality and the presence of DR among Indigenous Australians living in Central Australia.

Design:

Prospective cohort study. Participants: A total of 1257 individuals aged 40 y or older, living in one of 30 remote communities within Central Australia were recruited through outreach clinics.

Methods:

Fundus examination was performed on all patients at recruitment. The presence of any DR was recorded.

Main Outcome Measures:

Mortality rate and cause were obtained at 10 y, and their association with any DR was determined. Results: Ten-year all-cause mortality was found to be 29.3%. Of those with DM but no DR, 24.0% died during the 10 y after recruitment, compared with 40.1% for those with any DR (P < 0.0001). Those who had any DR were 75% more likely to die (hazard ratio [HR] 1.75; P < 0.0001) and were more likely to die from renal failure (HR 2.71; P = 0.004) or stroke (HR 5.91; P = 0.026).

Conclusion and Relevance:

The presence of any DR among those with DM, was associated with a 75% greater 10-y all-cause mortality rate and were more likely to die from renal failure or stroke. We recommend that whenever DR is noted among Indigenous Australians with DM, that they be immediately referred for investigation and management of risk factors, which might predispose to renal failure and stroke.