mam ibraheem, md, mph epidemic intelligence service officer centers for disease control and...

Mam Ibraheem, MD, MPHEpidemic Intelligence Service Officer

Centers for Disease Control and Prevention2012 CSTE Annual Conference

June 5, 2012

Visual Impairment Among Adults Aged ≥40 Years — New Mexico, 2008

Office of Surveillance, Epidemiology, and Laboratory ServicesScientific Education and Professional Development Program Office

Vision Loss : A Public Health Problem

Affects a lot of people 21 million have vision problems 80 million have potentially blinding diseases

Contributes large burden Morbidity: depression, diabetes, hearing impairment, stroke, falls,

cognitive decline, and premature death Quality of life: inability to drive, read, keep accounts, and travel Cost: estimated to exceed $51 billion

Vision Loss : A Public Health Problem

Recently increased and will increase in future Rapidly aging U.S. population and increasing epidemics of diabetes Blindness and visual impairment (VI) double by 2030

Perceived threat by public Vision loss ranks among top ten causes of disability in United States

Feasible to act on at community or public health level Early detection and treatment can prevent much blindness and vision

impairment Vision screening among adults aged ≥ 65 years: one of top 10 priorities

among effective clinical preventive services

National Response

Healthy People 2010 : Chapter 28 Vision Objectives National goal to "improve the visual and hearing health of the nation

through prevention, early detection, treatment, and rehabilitation“ National Eye Institute: lead agency for vision objectives 10 vision objectives

CDC’s Vision Health Initiative (VHI) Creates multilevel network for vision loss prevention and eye health

promotion Serves on the Healthy People 2020 Vision Work Group

May: Healthy Vision Month

Common Eye Disorders Among Adults Aged ≥40 Years

Cataracts Glaucoma

Diabetic Retinopathy Macular Degeneration

Vision Loss : At-Risk Populations

Hispanics and African Americans Increased risk for glaucoma and diabetes complications Unaddressed cataract

Older people at risk for age-related eye disease Diabetics Economically disadvantaged & socially isolated communities

Lack culturally relevant information and limited access to heath care

Rural communities lack education and limited health care access

Persons with modifiable risk factors?

Behavioral Risk Factor Surveillance System (BRFSS) Vision Surveillance

Optional “Visual Impairment and Access to Eye Care” module

First implemented in five states (Ohio, Texas, Louisiana, Iowa and Tennessee) in 2005

Individuals aged ≥40 years

9 questions assess prevalence of self-reported

Visual impairment

Eye disease

Eye examination

Implemented in NM in 2008

Access to eye care

Lack of eye care insurance

White, non-Hispanic

Hispanic American Indian or Alaska Native

Black Other

46.141.1

1.9 2.9

2008 Inter-Censal Race/Ethnicity Estimates NM US

Study Objectives

Estimate overall visual impairment (VI) prevalence in NM

Estimate VI prevalence by race/ethnicity

Assess association between race/ethnicity and VI

Assess covariates and identify populations most at risk for vision loss to guide prevention strategies

Methods

2008 BRFSS data for 4,743 New Mexico adults aged ≥40 years

BRFSS: complex cross-sectional survey

Far vision: “How much difficulty, if any, do you have in recognizing a friend across the street?”

Near vision: “How much difficulty, if any, do you have reading print in newspaper, magazine, recipe, menu, or numbers on the telephone?”

While wearing glasses or contact lenses, for those who wore them

Main Outcome: Two VI Case Definitions

No Difficulty

A little difficulty

Moderate difficulty

Extreme difficulty

Unable to do so because of eye sight

1. Broad: Any VI

2. Narrow: Moderate/Extreme VI Only

Far or Near Vision Question

Main Exposure and Covariates

Main Exposure: race/ethnicity Non-Hispanic white Hispanic American Indian or Alaska Native (AI/AN) Other, non-Hispanic

Covariates Demographics Socioeconomic status General health/comorbidity Access to general health care or eye care Lifestyle

Bivariate Analytic Methods

Survey-weighted percentages

P values associated with Pearson x2

P value <0.05 statistically significant relationship

Data analyzed using STATA® 12

VI Prevalence: Overall and by Race/EthnicitySu

Overall White, non-Hispanic Hispanic AI/AN

Broad (Any VI)Narrow (Moderate/Extreme VI Only)

Visual Impairment Prevalence by DemographicsCharacteristic Sample

SizeAny VI Moderate/Extreme VI

% 95% CI P value % 95% CI P value

Total 4743 44.9 43.1–46.8 20.4 19.0–21.9

Race/Ethnicity 4704 0.00 0.00

White, non-Hispanic 2890 40.5 38.3–42.9 17.2 15.5–19.1

Hispanic 1379 52.3 48.9–55.7 26.5 23.7–29.4

AI/AN 257 51.6 43.2–59.9 26.7 19.7–35.2

Sex 4743 0.03 0.08

Male 1833 42.7 39.8–45.7 19.0 16.8–21.4

Female 2910 46.9 44.6–49.2 21.6 19.8–23.5

Age groups (yrs) 4730 0.00 0.00

40–64 3026 46.7 44.4–49.0 21.3 19.5–23.2

≥65 1704 40.6 37.8–43.4 18.3 16.2–20.6

Total 4743 44.9 43.1–46.8 20.4 19.0–21.9

Hispanic 1379 52.3 48.9–55.7 26.5 23.7–29.4

AI/AN 257 51.6 43.2–59.9 26.7 19.7–35.2

Sex 4743 0.03 0.08

Male 1833 42.7 39.8–45.7 19.0 16.8–21.4

Female 2910 46.9 44.6–49.2 21.6 19.8–23.5

Age groups (yrs) 4730 0.00 0.00

40–64 3026 46.7 44.4–49.0 21.3 19.5–23.2

≥65 1704 40.6 37.8–43.4 18.3 16.2–20.6

Total 4743 44.9 43.1–46.8 20.4 19.0–21.9

Hispanic 1379 52.3 48.9–55.7 26.5 23.7–29.4

AI/AN 257 51.6 43.2–59.9 26.7 19.7–35.2

Sex 4743 0.03 0.08

Male 1833 42.7 39.8–45.7 19.0 16.8–21.4

Female 2910 46.9 44.6–49.2 21.6 19.8–23.5

Age groups (yrs) 4730 0.00 0.00

40–64 3026 46.7 44.4–49.0 21.3 19.5–23.2

≥65 1704 40.6 37.8–43.4 18.3 16.2–20.6

VI Prevalence by Socioeconomic CharacteristicsCharacteristic Sample

% 95% CI P % 95% CI P

Employment status 4738 0.00 0.00Employed 2343 43.5 40.9–46.1 17.6 15.7–19.6Unemployed 156 64.5 53.9–73.9 37.1 27.3–48.0

Education Level 4738 0.00 0.00Less than high school 598 57.1 51.8–62.2 34.0 29.1–39.2High school graduate 1233 51.8 48.1–55.5 23.3 20.5–26.4Attended college/technical school 1225 44.0 40.5–47.6 20.5 17.8–23.4College/technical school graduate 1682 36.7 33.8–39.7 13.8 11.8–16.0

Annual Household Income 4253 0.00 0.00<$15,000 586 61.0 55.7–66.0 37.8 32.7–43.2$15,000–$24,999 830 51.5 46.9–56.2 24.0 20.4–28.1$25,000–$34,999 557 49.0 43.5–54.5 23.0 18.6–28.1$35,000–$49,999 631 47.5 42.6–52.4 21.6 17.9–25.8≥$50,000 1649 37.1 34.2–40.1 13.8 11.9–15.9

% 95% CI P % 95% CI P

VI Prevalence by General Health and ComorbiditiesCharacteristic Sample

% 95% CI P % 95% CI P

Adults with “good” or better health 4730 0.00 0.00

“Good” or better health 3602 41.0 39.0–43.1 16.5 15.0–18.1

“Fair” or “poor” health 1128 58.4 54.5–62.1 33.9 30.4–37.5

Ever diagnosed with a stroke 4732 0.00 0.01

Yes 200 60.1 51.4–68.1 25.2 21.0–29.9

No 4532 44.3 42.4–46.1 19.6 18.1–21.2

Ever told by Dr. you have diabetes 4637 0.00 0.00

Yes 597 52.1 46.7–57.4 37.9 29.5–47.0

No 4040 43.9 41.9–45.9 19.6 18.2–21.1

% 95% CI P % 95% CI P

Yes 200 60.1 51.4–68.1 25.2 21.0–29.9

No 4532 44.3 42.4–46.1 19.6 18.1–21.2

Yes 597 52.1 46.7–57.4 37.9 29.5–47.0

No 4040 43.9 41.9–45.9 19.6 18.2–21.1

% 95% CI P % 95% CI P

Yes 200 60.1 51.4–68.1 25.2 21.0–29.9

No 4532 44.3 42.4–46.1 19.6 18.1–21.2

Yes 597 52.1 46.7–57.4 37.9 29.5–47.0

No 4040 43.9 41.9–45.9 19.6 18.2–21.1

% 95% CI P % 95% CI P

Yes 200 60.1 51.4–68.1 25.2 21.0–29.9

No 4532 44.3 42.4–46.1 19.6 18.1–21.2

Yes 597 52.1 46.7–57.4 37.9 29.5–47.0

No 4040 43.9 41.9–45.9 19.6 18.2–21.1

VI Prevalence by Access to General Health or Eye Care

Characteristic Sample Size

Any VI Moderate/Extreme VI

% 95% CI P % 95% CI P

Have any health care coverage 4738 0.00 0.00

Yes 4159 43.6 41.7–45.6 19.3 17.8–20.8

No 579 53.6 48.1–59.1 28.0 23.5–33.0

Could not see Dr. because of cost 4738 0.00 0.00

Yes 639 61.6 56.3–66.5 36.7 31.8–41.8

No 4099 42.2 40.2–44.1 17.7 16.3–19.2

Last time visited eye care provider 4710 0.00 0.00

<1m 519 38.6 33.2–44.3 16.8 12.9–21.7

1m–<1yr 2315 42.7 40.1–45.3 17.8 16.0–19.9

1yr–<2yr 805 43.0 38.8–47.4 18.9 14.8–22.4

≥2yr or never 1071 54.0 50.0–57.9 28.3 24.9–31.9

% 95% CI P % 95% CI P

Yes 4159 43.6 41.7–45.6 19.3 17.8–20.8

No 579 53.6 48.1–59.1 28.0 23.5–33.0

Yes 639 61.6 56.3–66.5 36.7 31.8–41.8

No 4099 42.2 40.2–44.1 17.7 16.3–19.2

<1m 519 38.6 33.2–44.3 16.8 12.9–21.7

1m–<1yr 2315 42.7 40.1–45.3 17.8 16.0–19.9

1yr–<2yr 805 43.0 38.8–47.4 18.9 14.8–22.4

≥2yr or never 1071 54.0 50.0–57.9 28.3 24.9–31.9

% 95% CI P % 95% CI P

Yes 4159 43.6 41.7–45.6 19.3 17.8–20.8

No 579 53.6 48.1–59.1 28.0 23.5–33.0

Yes 639 61.6 56.3–66.5 36.7 31.8–41.8

No 4099 42.2 40.2–44.1 17.7 16.3–19.2

<1m 519 38.6 33.2–44.3 16.8 12.9–21.7

1m–<1yr 2315 42.7 40.1–45.3 17.8 16.0–19.9

1yr–<2yr 805 43.0 38.8–47.4 18.9 14.8–22.4

≥2yr or never 1071 54.0 50.0–57.9 28.3 24.9–31.9

% 95% CI P % 95% CI P

Yes 4159 43.6 41.7–45.6 19.3 17.8–20.8

No 579 53.6 48.1–59.1 28.0 23.5–33.0

Yes 639 61.6 56.3–66.5 36.7 31.8–41.8

No 4099 42.2 40.2–44.1 17.7 16.3–19.2

<1m 519 38.6 33.2–44.3 16.8 12.9–21.7

1m–<1yr 2315 42.7 40.1–45.3 17.8 16.0–19.9

1yr–<2yr 805 43.0 38.8–47.4 18.9 14.8–22.4

≥2yr or never 1071 54.0 50.0–57.9 28.3 24.9–31.9

VI Prevalence by Lifestyle CharacteristicsCharacteristic Sample

% 95% CI P % 95% CI) P

Physical activity in last 30 days 4743 0.00 0.00

Yes 3494 42.3 40.2–44.4 17.9 16.3–19.5

No 1249 53.0 49.3–56.7 28.0 24.9–31.4

Current smoking 4729 0.09 0.01

Yes 796 48.7 43.9–53.4 25.9 22.1–30.0

No 3933 44.2 42.2–46.2 19.3 17.8–20.9

Heavy alcohol consumption 4676 0.40 0.70

Yes 159 49.2 39.5–58.8 22.1 14.9–31.4

No 4517 44.9 43.0–46.8 20.5 19.0–22.0

% 95% CI P % 95% CI) P

Yes 3494 42.3 40.2–44.4 17.9 16.3–19.5

No 1249 53.0 49.3–56.7 28.0 24.9–31.4

Yes 796 48.7 43.9–53.4 25.9 22.1–30.0

No 3933 44.2 42.2–46.2 19.3 17.8–20.9

Yes 159 49.2 39.5–58.8 22.1 14.9–31.4

No 4517 44.9 43.0–46.8 20.5 19.0–22.0

% 95% CI P % 95% CI) P

Yes 3494 42.3 40.2–44.4 17.9 16.3–19.5

No 1249 53.0 49.3–56.7 28.0 24.9–31.4

Yes 796 48.7 43.9–53.4 25.9 22.1–30.0

No 3933 44.2 42.2–46.2 19.3 17.8–20.9

Yes 159 49.2 39.5–58.8 22.1 14.9–31.4

No 4517 44.9 43.0–46.8 20.5 19.0–22.0

% 95% CI P % 95% CI) P

Yes 3494 42.3 40.2–44.4 17.9 16.3–19.5

No 1249 53.0 49.3–56.7 28.0 24.9–31.4

Yes 796 48.7 43.9–53.4 25.9 22.1–30.0

No 3933 44.2 42.2–46.2 19.3 17.8–20.9

Yes 159 49.2 39.5–58.8 22.1 14.9–31.4

No 4517 44.9 43.0–46.8 20.5 19.0–22.0

Summary

Any VI was significantly more prevalent among: Women Age 40 –64 years Unemployed Less than high school graduate Annual household income <$15,000 “Fair” or “Poor” health Stroke Diabetes No health care coverage Couldn’t see doctor because of cost Last time visited eye care provider: never or ≥2 years No physical activity in last 30 days

Multivariate Analytic Methods

Broad (Any VI) case definition only

Logistic regression model for complex-survey designs

Unadjusted and adjusted odds ratios

Data analyzed using STATA® 12

Odds Ratios for Any VI by Demographics

Characteristic Unadjusted OR

95% CI P value Adjusted OR

95% CI P value

Race/Ethnicity

White, non-Hispanic 1 1

Hispanic 1.60 1.36–1.89 0.00 1.17 0.97–1.42 0.10

AI/AN 1.56 1.09–2.21 0.01 1.21 0.83–1.78 0.31

Male 1

Female 1.18 1.01–1.37 0.03 1.07 0.91–1.27 0.37

Age groups(yrs)

40–64 1.28 1.10–1.48 0.00 1.28 1.04–1.57 0.02

≥65 1 1

95% CI P value

Race/Ethnicity

Hispanic 1.60 1.36–1.89 0.00 1.17 0.97–1.42 0.10

AI/AN 1.56 1.09–2.21 0.01 1.21 0.83–1.78 0.31

Male 1

Female 1.18 1.01–1.37 0.03 1.07 0.91–1.27 0.37

Age groups(yrs)

40–64 1.28 1.10–1.48 0.00 1.28 1.04–1.57 0.02

≥65 1 1

95% CI P value

Race/Ethnicity

Hispanic 1.60 1.36–1.89 0.00 1.17 0.97–1.42 0.10

AI/AN 1.56 1.09–2.21 0.01 1.21 0.83–1.78 0.31

Male 1

Female 1.18 1.01–1.37 0.03 1.07 0.91–1.27 0.37

Age groups(yrs)

40–64 1.28 1.10–1.48 0.00 1.28 1.04–1.57 0.02

≥65 1 1

95% CI P value

Race/Ethnicity

Hispanic 1.60 1.36–1.89 0.00 1.17 0.97–1.42 0.10

AI/AN 1.56 1.09–2.21 0.01 1.21 0.83–1.78 0.31

Male 1

Female 1.18 1.01–1.37 0.03 1.07 0.91–1.27 0.37

Age groups(yrs)

40–64 1.28 1.10–1.48 0.00 1.28 1.04–1.57 0.02

≥65 1 1

Odds Ratios for Any VI by Socioeconomic CharacteristicsCharacteristic Unadjusted

OR95% CI P Adjusted

OR95% CI P

Employment Status

Employed 1 1

Unemployed 2.36 1.49–3.73 0.00 2.01 1.24–3.28 0.01

Education Level

Did not graduate or graduated high school

1.74 1.49–2.03 0.00 1.37 1.13–1.66 0.00

Attended or graduated college/technical school

Annual Household Income

<$50,000 1.82 1.55–2.14 0.00 1.34 1.10–1.63 0.00

≥$50,000 1 1

OR95% CI P Adjusted

OR95% CI P

Employment Status

Employed 1 1

Unemployed 2.36 1.49–3.73 0.00 2.01 1.24–3.28 0.01

Education Level

1.74 1.49–2.03 0.00 1.37 1.13–1.66 0.00

<$50,000 1.82 1.55–2.14 0.00 1.34 1.10–1.63 0.00

≥$50,000 1 1

OR95% CI P Adjusted

OR95% CI P

Employment Status

Employed 1 1

Unemployed 2.36 1.49–3.73 0.00 2.01 1.24–3.28 0.01

Education Level

1.74 1.49–2.03 0.00 1.37 1.13–1.66 0.00

<$50,000 1.82 1.55–2.14 0.00 1.34 1.10–1.63 0.00

≥$50,000 1 1

OR95% CI P Adjusted

OR95% CI P

Employment Status

Employed 1 1

Unemployed 2.36 1.49–3.73 0.00 2.01 1.24–3.28 0.01

Education Level

1.74 1.49–2.03 0.00 1.37 1.13–1.66 0.00

<$50,000 1.82 1.55–2.14 0.00 1.34 1.10–1.63 0.00

≥$50,000 1 1

Odds Ratios for Any VI by General Health and Comorbidity

95% CI P Adjusted OR

95% CI P

Adults with “good” or better health

“Good” or better health 1 1

“Fair” or “poor” health 2.01 1.68–2.40 0.00 1.58 1.28–1.95 0.00

Ever diagnosed with a stroke

Yes 1.89 1.32–2.71 0.00 1.55 1.05–2.29 0.03

No 1 1

95% CI P

Yes 1.89 1.32–2.71 0.00 1.55 1.05–2.29 0.03

No 1 1

95% CI P

Yes 1.89 1.32–2.71 0.00 1.55 1.05–2.29 0.03

No 1 1

Odds Ratios for Any VI by Access to General Health and Eye Care Characteristics

95% CI P

Could not see Dr. because of cost

Yes 2.19 1.74–2.76 0.000 1.61 1.23–2.11 0.00

No 1 1

Last time visited eye care provider

<2yr 1 1

≥2yr or never 1.60 1.34–1.92 0.000 1.42 1.16–1.74 0.00

95% CI P

Yes 2.19 1.74–2.76 0.000 1.61 1.23–2.11 0.00

No 1 1

<2yr 1 1

≥2yr or never 1.60 1.34–1.92 0.000 1.42 1.16–1.74 0.00

95% CI P

Yes 2.19 1.74–2.76 0.000 1.61 1.23–2.11 0.00

No 1 1

<2yr 1 1

≥2yr or never 1.60 1.34–1.92 0.000 1.42 1.16–1.74 0.00

Discussion

NM-specific estimates of self-reported prevalence of VI

VI prevalence substantially higher by using broad (any VI) than narrow (M/E VI Only) case definitions

Comparison to other states?

Iowa Louisiana Ohio Tennessee Texas0

Any VI Among Adults Aged ≥50 Years — BRFSS, Five States (2005)

Iowa Louisiana Ohio Tennessee Texas New Mexico0

Any VI Among Adults Aged ≥50 Years — BRFSS, Five States (2005) and NM (2008)

Significant Associations with Any VI

Middle age: Access to care/Medicare?

Stroke history, “fair” or “poor” health: Less likely to comply with annual eye appointments?

Lower socioeconomic status (unemployed, lower education, lower income): May be associated with less access to eye care or limited vision health literacy?

Limited care access: medical cost, regular visits to eye care provider?

Nonsignificant Associations with Any VI

Demographics: race/ethnicity, sex and lifestyle factors: smoking, drinking, exercise Initial unadjusted associations confounded by other covariates Inconsistent with past literature: were past studies properly controlling

for confounding factors?

Comorbidity: Diabetes Diabetic retinopathy is a leading cause of visual impairment Outcome of interest in this study was VI from any cause

Study Limitations

Self-reported visual impairment BRFSS data collection by landline telephone Survey of civilian noninstitutionalized population Cross-sectional survey Not generalizable beyond NM population

Conclusions

VI prevalence varied substantially by different case definitions

VI prevalence highest among Hispanics and AI/ANs

Any VI in NM significantly associated with Middle age Stroke history Limited care access Lower socioeconomic status

Any VI in NM not significantly associated with race/ethnicity

Recommendations Address New Mexico’s VI disparities through vision health

initiative Access to eye care services Eye health literacy among groups at high risk

Continue surveillance of VI is important to better understand and plan for New Mexico’s vision care needs

Investigate eye care barriers to develop specific vision-loss prevention and eye-health promotion programs

Standardize case definition of vision loss in surveys and validate self-reporting methods

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Acknowledgments

Office of Surveillance, Epidemiology, and Laboratory ServicesScientific Education and Professional Development Program Office

NM DOH: Michael Landen Wayne Honey Tierney MurphyDan GreenMack Sewell

CDC: Julie MagriJohn CrewsSheryl LyssJinan SaaddineByron RobinsonBetsy Cadwell

Conceptual Model for the Development of VIBaselineAbsence

Psychological Attributes:Decreased Social Support

Depression

Personal Health Practice Factors:Decreased Physical Activity

No Knowledge of Eye DiseaseDecreased Intake of Antioxidant Supplements

Increased Incidence/Prevalence of VI

Common Eye Disorders

Infancy and Childhood (Birth to Age 18) Amblyopia, Strabismus, and Refractive Errors

Adults Younger Than Age 40 Refractive Errors, Eye Injury, and Diabetic Retinopathy

Adults Older Than Age 40 Cataract , Diabetic Retinopathy, Glaucoma, Macular Degeneration

Source: CDC’s Vision Health Initiative

Healthy People 2010 : Chapter 28 Vision Objectives 28-1: Increase the proportion of persons who have a dilated eye examination at

appropriate intervals 28-2: Increase the proportion of preschool children aged 5 years and younger

who receive vision screening 28-3: Reduce uncorrected visual impairment due to refractive errors 28-4: Reduce blindness and visual impairment in children and adolescents aged

17 years and younger 28-5: Reduce visual impairment due to diabetic retinopathy 28-6: Reduce visual impairment due to glaucoma 28-7: Reduce visual impairment due to cataract 28-8: Reduce occupational eye injury 28-9: Increase the use of appropriate personal protective eyewear in recreational

activities and hazardous situations around the home 28-10: Increase vision rehabilitation

Economic Impact of Vision Loss in the United States — Total $51 Billion

Source: CDC’s Vision Health Initiative

Vision Disability

BRFSS Vision/Eye Module How much difficulty, if any, do you have in recognizing a friend across the street? How much difficulty, if any, do you have reading print in newspaper, magazine,

recipe, menu, or numbers on the telephone? When was the last time you had your eyes examined by any doctor or eye care

provider? What is the main reason you have not visited an eye care professional in the past

twelve months? When was the last time you had an eye exam in which the pupils were dilated?

This would have made you temporarily sensitive to bright light. Do you have any kind of health insurance coverage for eye care? Have you been told by an eye doctor or other health care professional that you

NOW have cataracts? Have you EVER been told by an eye doctor or other health care professional that

you had glaucoma? Have you EVER been told by an eye doctor or other health care professional that

you had macular degeneration?

White, non-Hispanic

Hispanic American In-dian or Alaska

Native

Black Other

2008 Claritus Inter-Censal Estimates - NM

46.1 41.1 8 1.9 2.9

2008 BRFSS Weighted Percentages - NM

51.8 37.3 7.8 1.3 1.8

2008 Claritus Inter-Censal Estimates - US

64.8 15.7 0.740000000000001

12.3 6.4

5152535455565

Overall New Mexico and National Race/Ethnicity Estimates

mam ibraheem, md, mph epidemic intelligence service officer centers for disease control and...

Documents

vision problems80

vision obj

publicvision loss

population of people

population of older

visual impairment

hearing impairment

public health problemaffects