Incidence and risk of major heart diseases in middle-aged adults with moderate to severe vision impairment: a population-based cohort study

Associations of vision impairment and eye diseases with frailty in community-dwelling older adults: a nationwide longitudinal study in China

AIMS

To test whether vision impairment and major ophthalmic conditions are predictive of frailty.

METHODS

The analysis included 5321 participants aged 60-95 years at baseline from the China Health and Retirement Longitudinal Study. Participants were enrolled in 2011 and followed up in 2013, and 2015 through a face-to-face interview. Distance/near vision impairment was defined by reporting poor eyesight and reporting excellent, very good, good or fair eyesight was used as the reference. A history of cataract surgery and glaucoma were also self-reported. Frailty was defined as the presence of ≥3 of the five components of the Fried phenotype: weakness, slowness, exhaustion, inactivity and shrinking.

RESULTS

In the cross-sectional analysis, both near (odds ratio [OR] (95% confidence interval [CI]): 1.62 (1.30 to 2.00)) and distance (1.59 (1.30 to 1.96)) vision impairment was associated with a higher prevalence of frailty independent of confounders. In the longitudinal analysis, the multivariable-adjusted OR (95% CI) for incident frailty associated with glaucoma, distance vision impairment, near vision impairment and vision problem was 3.41 (1.46 to 7.99), 1.59 (1.17 to 2.17), 1.62 (1.17 to 2.23) and 2.11 (1.41 to 3.15), respectively. Vision problem was associated with decreased handgrip strength (β (95% CI): -1.47 (-2.20 to -0.75) kg) during follow-up. Individuals with glaucoma (-0.11 (-0.16 to -0.05) m/s), distance vision impairment (-0.02 (-0.03 to 0.00) m/s) or vision problem (-0.02 (-0.05 to 0.00) m/s) had decreased gait speed compared with the control group.

CONCLUSIONS

Vision problem, vision impairment and glaucoma are important predictors of frailty in older adults.

Factors Associated With Visual Impairment Among Adults With a History of Criminal Justice Involvement

The purpose of this study was to investigate the prevalence of and factors associated with visual impairment among adults with a history of criminal justice involvement (CJI). This retrospective, cross-sectional study reviewed adult respondents from the 2015-2018 National Survey on Drug Use and Health. We analyzed sociodemographic and health characteristics to determine factors associated with visual impairment among adults with and without a history of CJI. In this national, population-based study, we found similar rates of visual impairment among adults with and without CJI (5.7% vs. 4.2%, p < .001). However, adults with CJI were more likely to report visual impairment at a younger age. Among adults with CJI, visual impairment was associated with female sex, older age, Black/African American race, less education, lower income, and chronic health conditions (including diabetes, heart disease, respiratory illness, mental health symptoms, and hearing impairment). CJI in the past year (probation [adjusted odds ratio, AOR, 0.70; 95% confidence interval, CI, 0.53-0.93]; one arrest [AOR, 1.47; 95% CI, 1.14-1.89]; two or more arrests [AOR, 1.73; 95% CI, 1.29-2.33]) was uniquely associated with visual impairment among adults with a CJI history (p < .05 for all relationships). Research, screening, and treatment for visual impairment should include those with justice involvement to improve health equity.

Prevalence and correlates of vision impairment and its association with cognitive impairment among older adults in India: a cross-sectional study

OBJECTIVE

This study aimed to investigate the predictors of vision impairment in old age and how impaired vision is associated with cognitive impairment among the ageing population.

DESIGN

A cross-sectional study was conducted using a large country-representative survey data.

SETTING AND PARTICIPANTS

This study used data from the 'Building a Knowledge Base on Population Ageing in India' survey, conducted in 2011. Participants included 9541 older adults aged 60 years and above.

PRIMARY AND SECONDARY OUTCOME MEASURES

The outcome variables were vision impairment and cognitive impairment. Descriptive statistics along with bivariate analysis were presented. Additionally, multivariable binary logistic regression analysis was performed to fulfil the objectives.

RESULTS

A proportion of 59.1% of the respondents had vision impairment. Nearly 60% of the participants had cognitive impairment. Those who had vision impairment were 11% more likely to have cognitive impairment compared to their counterparts (OR: 1.11, 95% CI: 1.01 to 1.23). low psychological health (OR: 1.55; 95% CI: 1.36 to 1.77), low activities of daily living (OR: 1.80; 95% CI: 1.43 to 2.27), low instrumental activities of daily living (OR: 1.26; 95% CI: 1.14 to 1.40), poor self-rated health (OR: 1.28; 95% CI: 1.15 to 1.41) and chronic morbidity (OR: 1.27; 95% CI: 1.14 to 1.41) were found to be risk factors for cognitive impairment among older adults.

CONCLUSIONS

Additional efforts in terms of advocacy, availability, affordability and accessibility especially in a country with big illiteracy issue are mandatory to increase the reach of eye-care services and reduce the prevalence of avoidable visual impairment and vision losses that lead to cognitive deficits among the older population.

Association of Sensory Loss With the Knowledge of Heart Attacks

INTRODUCTION

Awareness of heart attack symptoms and the best response is a national public health priority, especially among those at higher risk of heart disease. Adults with sensory loss are more likely to develop heart disease than those without and may be at risk of poor heart attack knowledge owing to limited patient-provider communication and access to health information. The aim of this study is to examine the association between sensory loss and heart attack knowledge.

METHODS

Cross-sectional, nationally representative data from the 2014 and 2017 National Health Interview Survey were used. Analyses were conducted in 2021. Participants aged ≥20 years were included (N=61,168). Being aware of heart attack symptoms and the best response was considered as recognizing the 5 examined symptoms of heart attacks and the proper emergency response, as defined in the Healthy People 2020 objectives. Functional hearing and vision losses were defined as self-reported difficulty in hearing and seeing.

RESULTS

Overall, 16.2% reported functional hearing loss, and 10.1% reported vision loss. Having vision loss was associated with a lack of knowledge of heart attacks symptoms or the best response (prevalence ratio=1.08, 95% CI=1.06, 1.11). In a separate model, having vision loss only and dual sensory loss (concurrent vision and hearing loss) were associated with not having this knowledge (prevalence ratio=1.09, 95% CI=1.06, 1.12 and PR=1.08, 95% CI=1.01, 1.15, respectively), but having hearing loss only was not (prevalence ratio=1.03, 95% CI=0.99, 1.06).

CONCLUSIONS

Non-institutionalized adults with sensory loss may represent a group to target for improving the knowledge of heart attacks in the population.

Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review

Background

Major adverse cardiovascular events (MACE) are increasingly used as composite outcomes in randomized controlled trials (RCTs) and observational studies. However, it is unclear how observational studies most commonly define MACE in the literature when using administrative data.

Methods

We identified peer-reviewed articles published in MEDLINE and EMBASE between January 1, 2010 to October 9, 2020. Studies utilizing administrative data to assess the MACE composite outcome using International Classification of Diseases 9th or 10th Revision diagnosis codes were included. Reviews, abstracts, and studies not providing outcome code definitions were excluded. Data extracted included data source, timeframe, MACE components, code definitions, code positions, and outcome validation.

Results

A total of 920 articles were screened, 412 were retained for full-text review, and 58 were included. Only 8.6% (n = 5/58) matched the traditional three-point MACE RCT definition of acute myocardial infarction (AMI), stroke, or cardiovascular death. None matched four-point (+unstable angina) or five-point MACE (+unstable angina and heart failure). The most common MACE components were: AMI and stroke, 15.5% (n = 9/58); AMI, stroke, and all-cause death, 13.8% (n = 8/58); and AMI, stroke and cardiovascular death 8.6% (n = 5/58). Further, 67% (n = 39/58) did not validate outcomes or cite validation studies. Additionally, 70.7% (n = 41/58) did not report code positions of endpoints, 20.7% (n = 12/58) used the primary position, and 8.6% (n = 5/58) used any position.

Conclusions

Components of MACE endpoints and diagnostic codes used varied widely across observational studies. Variability in the MACE definitions used and information reported across observational studies prohibit the comparison, replication, and aggregation of findings. Studies should transparently report the administrative codes used and code positions, as well as utilize validated outcome definitions when possible.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-021-01440-5.

Prevalence and Related Risk Factors Associated with Coronary Heart Disease (CHD) Among Middle-Aged and Elderly Patients with Vision Impairment (VI)

Purpose

To investigate the prevalence and related risk factors associated with coronary heart disease (CHD) among middle-aged and elderly patients with vision impairment (VI).

Patients and Methods

The study was conducted with 1355 visually impaired adults over 45 years old, recruited from a Rehabilitation Hospital in China. Visual impairment is diagnosed by a doctor according to guidelines. Data were analyzed using multiple correspondence and logistic regression analysis. This research represents an important step towards the development of empirically based practical suggestions for decision-makers and health professionals that support visually impaired middle-aged and elderly people to participate in physical exercise and weight management when needed.

Results

Of the 1335 middle-aged and elderly adults (mean age ± SD, 63.56 ± 7.74 years; 45.6% male) with VI, a total of 154 (11.5%) developed CHD. In all people with VI, age (OR 1.47; 95% CI 1.16–2.02), hypertension (OR 2.14; 95% CI 1.46–3.14), diabetes (OR 3.79; 95% CI 2.29–6.27), blindness (OR 1.68; 95% CI 1.16–2.43), moderate activity (OR 0.86; 95% CI 0.69–0.98), and HR <60 beats/min (OR 1.43; 95% CI 1.08–2.48) are significantly related to CHD. Statistical analysis based on age grouping indicated that fasting plasma glucose, hypertension, diabetes, blindness, heart rate (<60 beats/min), and moderate activity were shown to have a strong association with development of CHD in age group <65 years (p < 0.05).

Conclusion

Compared with historical data, poorer vision degree, resting heart rate below 60 beats a minute and low physical activity level are emerging as new and increasing threats to CHD in middle-aged and elderly VI population. Interventions to enhance physical functioning and risk screening may be effective in the prevention of CHD in VI population.

Association of Vision Impairment With Preventive Care Use Among Older Adults in the United States

Importance

Preventive care is associated with decreased morbidity and mortality among older adults. Vision impairment may be a barrier to accessing care and health promotion information and therefore may contribute to decreased preventive care uptake.

Objective

To examine the association between self-reported vision impairment and uptake of preventive care services (ie, breast and colon cancer screenings and influenza and pneumococcal vaccinations).

Design, Setting, and Participants

Cross-sectional study using the 2015 and 2018 National Health Interview Survey (NHIS) and 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) data, national surveys of US residents conducted through in-person household interviews in NHIS, and state-based telephone interviews in BRFSS. Participants included respondents 50 years and older based on eligibility for each preventive care service examined.

Exposures

Vision impairment, defined as self-reported trouble seeing, in NHIS, and self-reported blindness/serious difficulty seeing in BRFSS.

Main Outcomes and Measures

Self-reported uptake of breast cancer screening (women aged 50-74 years), colon cancer screening (aged 50-74 years), influenza vaccination (50 years and older), and pneumococcal vaccination (65 years and older). Multivariable regression models adjusted for relevant confounders, including age, were used to examine the uptake of each preventive care service by vision impairment status.

Results

Among NHIS participants, older US individuals with vision impairment (prevalence between 14.3% and 16.3% in the different age groups; n = 12 120-29 654) were less likely to report breast cancer screening (odds ratio [OR], 0.82; 95% CI, 0.71-0.96) and colon cancer screening (OR, 0.89; 95% CI, 0.79-0.99) but not influenza (OR, 1.06; 95% CI, 0.97-1.15) and pneumococcal vaccination (OR, 1.03; 95% CI, 0.91-1.16), as compared with their counterparts without vision impairment. In BRFSS (n = 228 649-530 027), those with vision impairment (5.9%-6.8%) were less likely than those without vision impairment to report breast cancer screening (OR, 0.67; 95% CI, 0.59-0.75), colon cancer screening (OR, 0.70; 95% CI, 0.65-0.76), and pneumococcal vaccination (OR, 0.89; 95% CI, 0.81-0.99) but not influenza vaccination (OR, 0.95; 95% CI, 0.89-1.00).

Conclusions and Relevance

Older Americans with vision impairment may be less likely to use cancer-related preventive services as compared with their counterparts without vision impairments. These findings suggest that interventions to improve access to health information and health care services for individuals with vision impairment may be needed to improve cancer screening among this population.