Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Shanna Barnett


African Americans are disproportionately affected by diabetes mellitus (DM) and complications that include diabetic retinopathy and its disease and socioeconomic burdens. This study examined the relationships between diabetic retinopathy and health care utilization factors, such as gender, DM comorbidities of hypertension and hyperlipidemia, and health care access, among sampled African Americans with DM in the United States. The Andersen health care utilization model was the framework for the study. In this correlational cross-sectional study, data from the 2011-2016 National Health and Nutrition Examination Survey datasets were analyzed. Results of complex samples logistic regression showed that there were no significant associations between diabetic retinopathy and DM comorbidities of hypertension and hyperlipidemia, gender, and health care access, after controlling for hemoglobin A1C level, urine albumin-to-creatinine ratio (UACR), marital status, education level, and annual household income. UACR, annual household income, and adult education level were significantly associated with diabetic retinopathy (p <.005). Researchers might use findings from this study for further studies to establish cause-and-effect relationships between diabetic retinopathy and the related health utilization factors in this population. Positive social change might be effected by using results from the study in planning and developing effective public health interventions targeting specific African American populations, which might result in a reduction of the associated physical and socioeconomic burdens on these populations.