Association of disease‐specific causes of visual impairment and 10‐year mortality amongst Indigenous Australians: the Central Australian Ocular Health Study

Park

et al. 2019

IJERPH

The association between visual impairment and higher mortality remains unclear. In addition, evidence is lacking on the interaction between visual function and physical activity on mortality. We used data of individuals with no disability or with visual impairment among those who participated in the National Health Screening Program in Korea in 2009 or 2010. We constructed Cox proportional hazard models adjusted for potential confounders to evaluate the independent association between visual impairment and mortality. More severe visual impairment was associated with higher all-cause mortality (p-value for trend = 0.03) and mortality due to cardiovascular diseases (p-value for trend = 0.02) and that due to other diseases (p-value for trend = 0.01). We found an interaction on an additive scale between visual impairment and no physical activity on all-cause mortality (relative excess risk due to interaction = 1.34, 95% confidence interval: 0.37, 2.30, p-value = 0.01). When we stratified the study population by physical activity, the association between visual impairment and mortality was only found among individuals who did not engage in regular physical activity (p-value for trend = 0.01). We found an independent association between visual impairment and mortality and modification of this association by physical activity.

Section: Methodsmentioning

confidence: 99%

Modification of the Association between Visual Impairment and Mortality by Physical Activity: A Cohort Study among the Korean National Health Examinees

Park

et al. 2019

IJERPH

“…The mortality was merely 2.7% among 452 subjects without DR, while among DR patients, the mortality raised to 13.0%. Sabanayagam and coworkers [4] recruited 2,964 diabetic patients aged 40–80 years in Singapore; over a follow-up of 8.8 years, they found that the risk of all-cause mortality was significantly increased in DR patients, with a HR of 1.54 compared with subjects without DR. Few population-based studies, such as the Singapore Malay Eye Study [5] carried out in Singapore and the Central Australian Ocular Health Study [6] carried out in Austria, reported similar findings on the association between DR and mortality.…”

Section: Introductionmentioning

confidence: 85%

Diabetic Retinopathy, Visual Impairment, and the Risk of Six-Year Death: A Cohort Study of a Rural Population in China

et al. 2020

Purpose: To explore the association between diabetic retinopathy (DR) and the risk of six-year death, as well as the association between visual impairment (VI) and the risk of six-year death, in a rural Chinese population of age≥30 years. Methods: This was a population-based cohort study. In 2006-2007, 6,830 subjects aged ≥30 years were recruited from 13 villages in northern China through clustered randomization. In 2012-2013, a six-year follow-up was further done. Six different proportional hazards models, with different confounders adjusted, were used to explore the association between baseline DR and risk of death. Results: 5,570 subjects were included in this study by our inclusion and exclusion criteria. 410 (7.36%) subjects died by follow-up. The median ages of the dead subjects and survived subjects were 67 (interquartile range, IQR: 58-72) years and 52 (IQR: 42-58) years (Z=21.979, p<0.001). Male accounted for 62.20% and 44.92% among the dead and survived subjects (p<0.001). Besides, compared with those survived, the dead were found to be with lower education (p<0.001), lower marriage rate (p<0.001), lower income (p<0.001), higher proportion of smoking (p=0.003), higher systolic blood pressure (Z=10.411, p<0.001), lower body mass index (Z=-3.302, p=0.001), larger spherical equivalent error (Z=4.248, p<0.001), lower intraocular pressure (Z=-4.912, p<0.001), smaller anterior chamber depth (Z=-9.186, p<0.001), larger length thickness (Z=11.069, p<0.001), higher fast blood glucose level (Z=5.650, p<0.001), higher total cholesterols (Z=2.015, p=0.044), higher low-density lipoprotein (Z=2.024, p=0.043), higher proportion of drug usage (p<0.001). Besides, the dead subjects were more likely to be with VI, glaucoma, cataract, age-related macular degeneration, diabetes and DR. 148 subjects were diagnosed with DR at baseline, 33 (22.30%) of them were dead before follow-up. By adjusting all relative confounders in a proportional hazards model, DR was found to be a risk factor of six-year death, the hazard ratio (HR) was 1.739 (95% confidence intervals: 1.080, 2.803). Another five different statistical models with different confounders adjusted also revealed a statistically significant association between DR and six-year death. The association between VI and six-year death was not statistically significant. Conclusions: DR increased the risk of six-year death in a rural Chinese population aged ≥30 years, while VI not.

“…In the analysis of the subcategories, 98.4% of the deaths due to metabolic diseases (63 out of 64 deaths) were related to diabetes, and all deaths due to genitourinary diseases (all 24 deaths) were related to renal failure in the blindness group. Considering previous reports of an increased prevalence of diabetes in visually impaired individuals in Korea (adjusted OR = 2.273, 95% CI = 1.503-3.437) and reports on the relationship between mortality and diabetic retinopathy, increased mortality in the blindness group may be mainly associated with diabetes 9,16,19,21,[28][29][30][31] . In a retrospective cohort analysis of indigenous Australians, of the diverse disease-specific causes of visual impairment, only visual impairment due to diabetic retinopathy increased the 10-year mortality after adjustments for age, sex and the presence of systemic hypertension (HR = 1.70, 95% CI = 1.00-2.87, P = 0.049) 19,31 .…”

Section: Discussionmentioning

confidence: 99%

“…After the submission of the required data, the processes of reviewing and confirming the data were performed by ophthalmologists hired by the government 2,7 . The other advantage of this study was that mortality was analyzed in all age groups; many previous cohort studies enrolled only adult populations 3,15,31 . The HRs of mortality were significantly higher in both the young and the old age subgroups of the blind cohort in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Second, the presenting visual acuity or the presence of neovascular age-related macular degeneration, which are reported to have relatively superior predictive value for mortality, could not be used in this study because of limitations in the disability registration data regarding visual function 15,21,39 . Additionally, individuals with treatable transient blindness conditions, especially those caused by severe cataracts, could not be included in the blindness group in this study, in contrast with previous papers 15,18,31,40 . However, considering the easy accessibility of cataract surgery in South Korea, this limitation was not a serious disadvantage of this study.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mortality and causes of death in a population with blindness in Korea: A longitudinal follow-up study using a national sample cohort

Choi

Lee

2020

Sci Rep

The influence of visual impairment and blindness on the risk of mortality has been reported in diverse cohort studies. However, the results reported have varied from nonsignificant to significant associations. In the present study, we evaluated the influence of blindness on the risk of mortality from 2002 to 2013 using a longitudinal database with a national sample cohort provided by the Korean National Health Insurance Service. Of a total of 1,125,691 subjects, 1,279 subjects who were registered as blind were enrolled, and 5,116 control participants were matched at a 1:4 ratio for age, sex, income, region of residence, and medical histories of hypertension, diabetes mellitus and dyslipidemia. The life/ death information contained in this dataset was used for the analysis; this information was originally recorded by the medical doctors on the death certificates of the participants. The percentage of total deaths during the mean follow-up period of 111.0 ± 41.6 months was 28.1% in the blindness group and 19.7% in the matched control group. The risk of mortality was significantly higher in the blindness group than in the control group according to the Cox proportional hazards model with additional adjustments for ischemic heart disease, stroke, and depression (adjusted hazard ratio [HR] of mortality = 1.54, 95% confidence interval [CI] = 1.37-1.74, P < 0.001). In the subgroup analyses, the adjusted HRs for mortality were significantly higher in the blindness group than in the control group regardless of age (young defined as <60 years old vs old defined as ≥60 years old) and sex. The percentage of death due to metabolic diseases and genitourinary diseases was higher in the blindness group than in the matched control group. Sensory impairments are common among the elderly population 1-3. In particular, visual impairment, including blindness, negatively impacts functional independence, cognition, and mental health, consequently resulting in reduced quality of life 3-7. According to the criteria of the World Health Organization (WHO), visual impairment is defined as presenting vision worse than 20/60 (or 6/18) in the better seeing eye and blindness as vision worse than 20/400 (or 3/60) in the better seeing eye 1,8. According to population-based studies, the reported prevalence of visual impairment ranges from 0.35% to 2.54%, and that of blindness ranges from 0.1% to 1.02% according to the WHO criteria 9. The influence of visual impairment and blindness on the risk of mortality has been reported in diverse cohort studies, but the results have varied from nonsignificant to significant associations, and the relative risk (RR) has varied from 1.17 to 3.60 8,10-19. The risk of mortality associated with visual impairment was well summarized in a recent meta-analysis including 29 studies with a total of 269,839 participants and 67,061 deaths 8. Of the 29 included studies, 17 studies reported a significant association between visual impairment and the risk of mortality, but the rest of the studies failed to identify a signifi...