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David J Lee, Dandan Diane Zheng, Sharon L Christ, Byron L Lam, Laura A McClure; Visual Impairment, Multi-Morbidity and Their Association with Short Term Mortality. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4460. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Visual impairment (VI) is among the most disabling conditions. VI and visual disorders often co-occur with other disabling chronic conditions. This research identifies chronic disease patterns and their relationship to VI and estimates the associated mortality risk in a national representative population.
Using data from 27,731 participants aged 18 years and older of the 2009 National Health Interview Survey, we employed latent class analysis (LCA) to identify subgroups of participants based on their combination of chronic illnesses; 14 self-reported disease/conditions including visual impairment were utilized. Mortality linkage with National Death Index was performed through December 31, 2011. Survival analyses were conducted to assess how the derived latent class membership predicted short-term mortality.
LCA identified 5 different groups with 70% of participants belonging to the healthy group with low chronic disease prevalence. The other four groups represented various degrees and patterns of multi-morbidity and were labeled accordingly: 10.9% population belongs to the “mildly impaired group” with a 59% chance of arthritis and 20% of VI; 13.6% belong to the “hypertensive diabetic group” with high prevalence of hypertension (87%) and diabetes (43%) and a 12.6% chance of VI; 3.0% are in “heart disease group” with high chance of coronary heart disease (93%) or myocardial infarction (50%), and 2.2% belong to the “severely impaired group” with 83% chance of arthritis, 60% of hearing impairment and 40% of VI. 647 deaths were identified with average follow-up time of 2.5 years. After controlling for survey design, age, gender, race, Hispanic origin, education, BMI, smoking and alcohol drinking status, compared to the healthy group, participants in four latent groups had elevated mortality risk: heart disease group Hazard Ratio (HR) 2.04 (95% confidence interval [1.42, 2.91]); hypertensive & diabetic group (1.54 [1.15, 2.06]); mildly impaired group (1.83 [1.35, 2.48]); and severely impaired group (3.80 [2.46, 5.85]).
VI contributed to membership in 3 of 4 distinct multi-morbidity groups collectively representing 25% of the US population. The prevalence rate of VI was highest in the severely impaired group (40%) which also had the highest hazard for mortality (3.8). Clinicians should be aware that patients with VI may also have other chronic conditions that may impact mortality risk.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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