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D. D. Zheng, K. McCollister, D. J. Lee, B. Lam, K. L. Arheart, A. J. Caban-Martinez, E. P. Davila, S. Christ; Disparities in Quality-Adjusted Life Years Associated With Self-Reported Visual Impairment: The 2000-2003 Medical Expenditure Panel Survey. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5709.
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The economic consequences of visual impairment (VI) have generally been assessed via ocular care expenditures and reduced productivity. Our purpose is to estimate and compare quality-adjusted life years (QALYs) by self-reported VI categories for race/ethnic subpopulations.
The Medical Expenditure Panel Survey (MEPS) consists of a nationally representative sub-sample of the National Health Interview Survey (NHIS). MEPS contains questions from the EuroQol 5D, a QALY-compatible instrument that generates health utility values that can be linked with mortality data to calculate quality-adjusted life expectancy. Data from 2000-2003 were available on 49,111 individuals 18 years of age and older. Participants were asked to indicate if they had trouble seeing even with corrective lenses (some VI) or were unable to see at all (severe VI). For race/ethnic analyses we combined the two VI categories (any VI) to compare with individuals reporting no VI. Survey-adjusted regression analyses were conducted to estimate the overall difference in QALYs by VI status and race/ethnic subpopulations.
Relative to those with no VI, individuals aged 18-44 who reported severe VI had 10.4 fewer QALYs and those with some VI had 5.2 fewer QALYs (p values< 0.01). QALY decrements were similar for males and females with any VI relative to no VI. Blacks and whites with any VI had the greatest QALY decrements relative to their counterparts with no VI (10.5 fewer QALYs, on average). Asian Pacific Islanders and Other/multi race individuals with any VI also had nearly 9 fewer QALYs than their counterparts with no VI (p values< 0.01). American Indians with any VI had about 1.9 fewer QALYs than their counterparts with no VI, but these results were not statistically significant. Relative to non-Hispanics, most Hispanics had relatively greater quality-adjusted life expectancy regardless of VI status. Within Hispanic group, Puerto Ricans with any VI had the greatest reduction in QALYs relative to those with no VI (11.6 fewer QALYs, p value<0.01). Cubans and Mexicans with any VI had between 8-10 fewer QALYs than their counterparts with no VI (p values< 0.01).
Findings from this nationally representative sample of community-residing adults indicate that regardless of sociodemographic subgroup, participants reporting severe VI had approximately half the QALYs (i.e., fewer years of optimal health) relative to those reporting some VI. Our findings also highlight the large race/ethnic disparities in quality of life that exist among the visually impaired.
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