title: Language barrier and its relationship to diabetes and diabetic retinopathy.
abstract: BACKGROUND
  Language barrier is an important determinant of health care access and health. We examined the associations of English proficiency with type-2 diabetes (T2DM) and diabetic retinopathy (DR) in Asian Indians living in Singapore, an urban city where English is the predominant language of communication.
  
  
  METHODS
  This was a population-based, cross-sectional study. T2DM was defined as HbA1c ≥6.5%, use of diabetic medication or a physician diagnosis of diabetes. Retinal photographs were graded for the severity of DR including vision-threatening DR (VTDR). Presenting visual impairment (VI) was defined as LogMAR visual acuity > 0.30 in the better-seeing eye. English proficiency at the time of interview was assessed.
  
  
  RESULTS
  The analyses included 2,289 (72.1%) English-speaking and 885 (27.9%) Tamil-speaking Indians. Tamil-speaking Indians had significantly higher prevalence of T2DM (46.2 vs. 34.7%, p < 0.001) and, among those with diabetes, higher prevalence of DR (36.0 vs. 30.6%, p < 0.001), VTDR (11.0 vs. 6.5%, p < 0.001), and VI (32.4 vs. 14.6%) than English speaking Indians. Oaxaca decomposition analyses showed that the language-related discrepancies (defined as the difference in prevalence between persons speaking different languages) in T2DM, DR, and VTDR could not be fully explained by socioeconomic measures.
  
  
  CONCLUSIONS
  In an English dominant society, Tamil-speaking Indians are more likely to have T2DM and diabetic retinopathy. Social policies and health interventions that address language-related health disparities may help reduce the public health impact of T2DM in societies with heterogeneous populations.
authors.affiliation: Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, #05-00, Singapore, 168751, Singapore.
authors.forename: Yingfeng
authors.initials: Y
authors.lastname: Zheng
authors.forename: Ecosse L
authors.initials: EL
authors.lastname: Lamoureux
authors.forename: Pei-Chia Peggy
authors.initials: PC
authors.lastname: Chiang
authors.forename: Ainur Rahman
authors.initials: AR
authors.lastname: Anuar
authors.forename: Jie
authors.initials: J
authors.lastname: Ding
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: E-Shyong
authors.initials: ES
authors.lastname: Tai
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
mesh_terms: D000069:Acculturation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000208:ethnology* / Q000706:statistics & numerical data; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D005128:Eye Diseases / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology; D012923:Social Class; D011795:Surveys and Questionnaires; D014171:Transients and Migrants / Q000523:psychology / Q000706:statistics & numerical data; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data