Visual impairment and unintentional injury mortality: the National Health Interview Survey 1986-1994

PURPOSE: To examine the relationship between reported visual impairment and unintentional injury mortality. DESIGN: Mortality linkage study of a population-based survey. METHODS: Mortality linkage through 1997 of 116,796 adult participants, aged 18 years and older, from the 1986 to 1994 National Health Interview Survey was analyzed with respect to reported visual impairment using Cox regression models.The average follow-up was 7.0 years, and 295 unintentional injury deaths were identified. After controlling for survey design, age, sex, and the presence and number of eye diseases, participants with severe, bilateral visual impairment were at increased risk of death relative to participants without visual impairment (hazard ratio: 7.4; 95% confidence interval: 3.0-17.8). CONCLUSIONS: Our data provide evidence that severe, bilateral visual impairment is associated with an increased risk of unintentional mortality among adults in the United States.     

Glaucoma and survival: the National Health Interview Survey 1986-1994

OBJECTIVE: Associations between glaucoma and survival have not been studied extensively, in part, because of the relatively low prevalence of this condition. This study examines associations between self-reported glaucoma and mortality in a nationally representative sample of U.S. adults. DESIGN: Annual cross-sectional multistage area probability survey of the U.S. civilian noninstitutionalized population living at addressed dwellings. PARTICIPANTS: Mortality linkage with >96% of participants from the 1986 to 1994 National Health Interview Survey was performed by the National Center for Health Statistics through 1997. Complete data were available on 116796 adults >or=018 years old. METHODS: Adults within randomly selected households were administered a chronic conditions list that included questions about glaucoma and visual impairment. Proxy information on these conditions was obtained when household members were unavailable for interview. Statistical methods included Cox regression models with adjustments for covariates, as well as for the complex sample survey design. MAIN OUTCOME MEASURE: All-cause mortality and cardiovascular and cancer mortality. RESULTS: A total of 1559 (1.3%) glaucoma cases were reported. Nearly 19% of participants with reported glaucoma also had reported visual impairment (n = 303). Mortality linkage identified 8949 deaths; the average follow-up was 7.0 years. After controlling for survey design, gender, age, race, marital status, education level, and self-rated health, participants with reported glaucoma but without reported visual impairment were at significantly increased risk of death relative to participants without reported glaucoma, irrespective of visual impairment status (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.19-1.53); similar associations were found for participants with reported glaucoma and visual impairment vs. participants with no reported glaucoma (HR, 1.39; 95% CI, 1.14-1.71). An increased risk of cardiovascular disease mortality was found for participants with reported glaucoma both without (HR, 1.31; 95% CI, 1.11-1.55) and with (HR, 1.53; 95% CI, 1.15-2.05) reported visual impairment. Risk of mortality due to cancer was increased only in participants with reported glaucoma but without reported visual impairment (HR, 1.57; 95% CI, 1.25-1.98); this association was stronger when the mortality analysis was restricted to cancers amenable to early screening, including breast, cervical, colon, and prostate cancer (HR, 1.99; 95% CI, 1.41-2.81). CONCLUSIONS: Among adults residing in the United States, reported glaucoma is associated with an increased risk of all-cause and cardiovascular disease mortality. Associations between glaucoma and cancer were inconsistent and may reflect, in part, a detection bias, in which glaucoma is more likely to be diagnosed in adults receiving health care because of other medical conditions.     

Visual impairment and functional status from the 1995 National Health Interview Survey on Disability

PURPOSE: The purpose of this project is to evaluate the association of vision limitation and function among a population of older and younger adults. METHODS: The effects of self-reported serious difficulty with vision and legal blindness were evaluated on six activities of daily living (ADLs) and six instrumental activities of daily living (IADLs). Subjects were 67,570 adults over the age of 18 who participated in the 1995 National Health Interview Survey on Disability. RESULTS: Serious difficulty with vision (SDV) and legal blindness (LB) were independently associated with increased odds of poorer function for each of the ADLs and IADLs. In stratified analysis, the effect of vision on function was modified by age. Both SDV and LB produced a greater impact on performance of ADLs and IADLs among younger rather than older subjects. CONCLUSIONS: Vision had an impact on all ADLs and IADLs evaluated, with greater impact on self-reported function for younger adults. This suggests that younger adults perceive limitations associated with visual disability differently than do older adults.     

Visual impairment and functional status from the 1995 National Health Interview Survey on Disability

purpose?The purpose of this project is to evaluate the association of vision limitation and function among a population of older and younger adults. methods?The effects of self-reported serious difficulty with vision and legal blindness were evaluated on six activities of daily living (ADLs) and six instrumental activities of daily living (IADLs). Subjects were 67,570 adults over the age of 18 who participated in the 1995 National Health Interview Survey on Disability. results?Serious difficulty with vision (SDV) and legal blindness (LB) were independently associated with increased odds of poorer function for each of the ADLs and IADLs. In stratified analysis, the effect of vision on function was modified by age. Both SDV and LB produced a greater impact on performance of ADLs and IADLs among younger rather than older subjects. conclusions?Vision had an impact on all ADLs and IADLs evaluated, with greater impact on self-reported function for younger adults. This suggests that younger adults perceive limitations associated with visual disability differently than do older adults.     

Prevalence of usual-corrected binocular distance visual acuity impairment in Hispanic and non-Hispanic adults

OBJECTIVES. The purpose of this study was to perform comparative analyses of the population-based prevalence of usual-corrected binocular distance visual acuity impairment among Hispanics and non-Hispanics in the United States. METHODS. Data from the Hispanic Health and Nutrition Examination Survey (HHANES), 1982-1984, and the National Health and Nutrition Examination Augmentation Survey I (NHANES I-A), 1974-1975, were analyzed to investigate the epidemiology of usual-corrected binocular distance acuity in adults 25 to 74 years of age among Cuban-Americans (N=396), Mexican-Americans (N=1,381), Puerto Ricans (N=513), African-Americans (N=250), and non-Hispanic white Americans (N=2,660). Binocular distance acuity was assessed using Sloan Letters or Landolt Rings with the participants wearing their corrective lenses, if any. RESULTS. Prevalences of 20/50 or worse usual-corrected binocular distance acuity were 3.5%, 4.6%, and 6.6% for Cuban-Americans, Mexican-Americans, and Puerto Ricans, respectively, in the HHANES; and 7.7% and 4.1% for African-Americans and non-Hispanic whites, respectively, in the NHANES I-A. Within the HHANES, after adjustment for gender and age, Puerto Rican adults were found to have a significantly higher prevalence of visual impairment (20/50 or worse) and were significantly less likely to become unimpaired with usual correction than Cuban-American adults. Within the NHANES I-A, African-Americans were found to have a higher prevalence of visual impairment (20/50 or worse) and were significantly less likely to become unimpaired with usual correction than non-Hispanic whites. Higher prevalences of visual impairment (20/50 or worse) were associated with increasing age for all ethnic groups. After controlling for age, odds of usual-corrected visual impairment (20/50 or worse) were significantly higher in women than in men for Cuban-Americans and Mexican-Americans (odds ratios: 4.5 and 2.6, respectively). CONCLUSIONS. The results from this study suggest that compared to other Hispanic groups and non-Hispanic whites, Puerto Rican and African-American adults may not be receiving similar eye care services and/or may have more severe eye diseases.