Open Access Open Badges Research article

Language barrier and its relationship to diabetes and diabetic retinopathy

Yingfeng Zheng12, Ecosse L Lamoureux13, Pei-Chia Peggy Chiang1, Ainur Rahman Anuar145, Jie Ding1, Jie Jin Wang36, Paul Mitchell6, E-Shyong Tai8 and Tien Y Wong137*

Author Affiliations

1 Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, #05-00, Singapore, 168751, Singapore

2 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, #54 Xianlie Road, Guangzhou, 510060, China

3 Centre for Eye Research Australia, University of Melbourne, the Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, VIC, 3002, Australia

4 University of Malaya Eye Research Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

5 Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia

6 Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, NSW, 2145, Australia

7 Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

8 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

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BMC Public Health 2012, 12:781  doi:10.1186/1471-2458-12-781

Published: 13 September 2012



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.


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.


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.


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.

English proficiency; Asian indians; Diabetes; Diabetic retinopathy; Visual impairment