Prevalence of Diabetic Retinopathy and Cardiovascular Risk Factors Among Diverse Hispanic/Latino Adults: HCHS/SOL and SOL Ojos Results.

Abstract

Objective: To estimate diabetic retinopathy (DR) prevalence among Hispanic/Latino adults with diabetes, assess heterogeneity by background group, and evaluate cardiovascular disease (CVD) risk factors.

Design: Cross-sectional analysis of SOL Ojos, a multicenter ancillary study embedded within the population-based Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Participants: Adults aged ≥40 years completing HCHS/SOL Visit 3 (V3; 2020-2024) from Chicago and Miami were examined (3,294/3,864; 85.2%). The analytic sample included 1,224 participants with diabetes and gradable retinal imaging (mean age, 62.7 years [95% CI, 61.4-64.0]; 48.6% female).

Methods: Participants underwent standardized ophthalmic examinations with centrally graded ultra-widefield fundus imaging. Major CVD risk factors (diabetes, hypertension, hypercholesterolemia, obesity, smoking) were assessed at V3 and analyzed individually and cumulatively. DR, macular edema (ME), and vision-threatening DR (VTDR) were graded using Early Treatment Diabetic Retinopathy Study (ETDRS) protocols. Survey-weighted analyses estimated age-standardized prevalence, and sequentially adjusted logistic regression evaluated associations.

Main outcome measures: Age-standardized prevalence of DR outcomes and associations with CVD risk factors.

Results: Age-standardized any DR prevalence was 34.7% (95% CI, 29.2-40.2). Among men, any DR and VTDR prevalence was 41.8% (95% CI, 33.5-50.0) and 13.4% (95% CI, 7.4-19.5), versus 27.2% (95% CI, 19.5-34.9) and 9.4% (95% CI, 1.4-17.4) among women. Any DR ranged across Hispanic/Latino backgrounds from 13.9% (95% CI, 1.8-26.0) to 55.4% (95% CI, 49.2-61.6) in men and 15.3% (95% CI, 4.4-26.2) to 39.2% (95% CI, 22.3-56.1) in women, with the highest estimates among Cuban individuals. CVD risk factors were common and clustered (≥4: men 42.7% [95% CI, 34.5-50.9]; women 35.6% [95% CI, 29.3-41.9]). In adjusted models, hypertension was associated with any DR (OR, 3.16 [95% CI, 1.76-5.65]) and VTDR (OR, 2.86 [95% CI, 1.05-7.79]). Overall cumulative CVD risk burden was not significantly associated with VTDR (Type III F test, P=0.1193), despite adjustment for diabetes duration; the 3-risk-factor category had higher estimated odds than the 1-risk-factor category (OR, 5.10 [95% CI, 1.22-21.39]).

Conclusion: In this cross-sectional study of Hispanic/Latino adults with diabetes, more than one-third had DR, with substantial heterogeneity across background groups. Hypertension was associated with DR outcomes, particularly VTDR. Findings provide contemporary prevalence estimates and support longitudinal evaluation of cardiometabolic risk and DR outcomes.