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Kevin D. Frick, Lori L. Grover, Elizabeth Wehler; Excess Expenditures, Excess Informal Care Days, and Quality of Life Decrements Associated with Self-Reported Visual Impairment and Blindness. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6939.
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To update a previous estimate of the increases in medical care expenditures and informal care days, and the decrement in health related quality of life associated with self-reported visual impairment (problems reading newsprint and/or seeing faces even with correction) and blindness.
Data from the Medical Expenditure Panel Survey in the United States (2003-2008) were merged. The analytic data file included only those who were aged 40 or older with no missing data on total health care expenditures, days of informal care received, SF-36 physical and mental component summary scores, and potential confounders including race, age, education, family poverty status, self-reported health, diabetes, high blood pressure, sex, race/ethnicity, and being uninsured. Simple linear regressions were run to test for differences without controlling for confounders. Multivariable linear regressions were run to assess the association between vision impairment, expenditures, informal care days, and quality of life after controlling for confounders. All regressions were weighted and accounted for the complex study design to make the results generalizable to the United States population Expenditures from each year were adjusted to 2011 dollars using the medical care consumer price index before analysis.
Of the 201,809 individual-years in the data from 2003-2008, 70,896 met inclusion criteria. Blind individuals spent $5280 [95%CI 3231, 7329] more than the average for non-visually impaired individuals ($5242). Those who self-reported impairment spent an extra $2939 [95%CI 2440, 3438]. After controlling for potential confounders, blindness was still associated with $2122 excess expenditures [95% CI 192, 4051] and impairment was associated with $864 excess expenditures [95% CI 405, 1322]. In the analyses controlling for confounders, only impairment was statistically significantly associated with a greater burden (1.3 excess days, 95% CI 0.63, 2.0). On the SF-36 PCS, after controlling for confounding impairment was associated with a 2.0 unit decrement [95% CI -2.3, -1.7] and blindness was associated with a 2.9 unit decrement [95% CI -4.1, -1.7]. For the SF-36 MCS, both impairment (-2.6, 95% CI -2.9, -2.2) and blindness (-2.5, 95% CI -4.4, -0.61) were associated with decrements.
Blindness and self-reported visual impairment are associated with excess medical care expenditures, excess days of informal care, and decrements to quality of life. With an aging United States population, the per person burden will translate into an increasing societal burden unless methods of preventing blindness or reducing its individual burden are developed.
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