RACIAL-DIFFERENCES IN THE CAUSE-SPECIFIC PREVALENCE OF BLINDNESS IN EAST BALTIMORE
RACIAL-DIFFERENCES IN THE CAUSE-SPECIFIC PREVALENCE OF BLINDNESS IN EAST BALTIMORE
复制标题
DOI：
10.1056/nejm199111143252004
复制
发表时间：
1991-11-14
影响因子：
158.5
通讯作者：
EZRINE, S
中科院分区：
文献类型：
--
作者：
SOMMER, A;TIELSCH, JM;EZRINE, S
背景。双侧失明与简单的折射率无关，黑人在白人中的普遍是两倍，尽管老年人之间的差异变窄。这种与年龄相关的模式的原因是不确定的。方法和结果。一个随机选择的，分层的，多阶段的聚类样本，分别是2395个黑人和2913名白人，40岁及以上的东巴尔的摩，由一个团队进行了详细的眼科检查。我们确定了64位在两只眼睛中盲目的受试者。失明的主要原因是无效的老年白内障（在128只眼睛中有27只失明），主要的开态青光眼（17眼）和与年龄相关的黄斑变性（16眼）。在此样本中，这三种疾病占所有失明的47％。无效的白内障占黑人所有失明的27％，其中占白人的四倍。白人比黑人在80岁之前进行白内障提取的可能性几乎高出50％（p <0.002）。原发性开角青光眼占黑人所有失明的19％。在黑人中，这是白人中的六倍，并且平均在10年前开始。相比之下，与年龄相关的黄斑变性导致失明，仅限于白人，其中这是失明的主要原因（普遍存在，每1000； 95％的置信区间为1.2至5.4）；它影响了80岁或以上的所有白人受试者中的3％。在黑人和白人中，巴尔的摩城市中的失明模式似乎有所不同。白人更有可能具有与年龄相关的黄斑变性，黑人具有主要的开角青光眼。年轻黑人和两个种族的老年对象中，无手术的高率率很高，这表明卫生服务不足。在城市人口中，所有失明的一半可能是可以预防或可逆的。
Background. Bilateral blindness unrelated to simple refractive error is twice as prevalent among blacks as among whites, although the difference narrows among the elderly. The reasons for this race- and age-related pattern are uncertain.Methods and Results. A randomly selected, stratified, multistage cluster sample of 2395 blacks and 2913 whites 40 years of age and older in East Baltimore underwent detailed ophthalmic examinations by a single team. We identified 64 subjects who were blind in both eyes. The leading causes of blindness were unoperated senile cataract (accounting for blindness in 27 of the total of 128 eyes), primary open-angle glaucoma (17 eyes), and age-related macular degeneration (16 eyes). Together, these three disorders accounted for 47 percent of all blindness in this sample. Unoperated cataract accounted for 27 percent of all blindness among blacks, among whom it was four times more common than among whites; whites were almost 50 percent more likely than blacks to have undergone cataract extraction before the age of 80 (P < 0.002). Primary open-angle glaucoma accounted for 19 percent of all blindness among blacks; it was six times as frequent among blacks as among whites and began 10 years earlier, on average. By contrast, age-related macular degeneration resulting in blindness was limited to whites, among whom it was the leading cause of blindness (prevalence, 2.7 per 1000; 95 percent confidence interval, 1.2 to 5.4); it affected 3 percent of all white subjects 80 years of age or older.Conclusions. The pattern of blindness in urban Baltimore appears to be different among blacks and whites. Whites are far more likely to have age-related macular degeneration, and blacks to have primary open-angle glaucoma. The high rate of unoperated cataracts among younger blacks and among elderly subjects of both races suggests that health services are underused. Half of all blindness in this urban population is probably preventable or reversible.