Karpa Michael J, Mitchell Paul, Beath Ken, Rochtchina Elena, Cumming Robert G, Wang Jie Jin
Centre for Vision Research, Department of Ophthalmology, and Westmead Millennium Institute, Australia.
Arch Ophthalmol. 2009 Oct;127(10):1347-53. doi: 10.1001/archophthalmol.2009.240.
To investigate pathways from visual impairment to increased all-cause mortality in older persons.
The Blue Mountains Eye Study examined 3654 persons 49 years and older (82.4% response) during 1992-1994 and after 5 and 10 years. Australian National Death Index data confirmed deaths until 2005. Visual impairment was defined as presenting, correctable, and noncorrectable, using better-eye visual acuity. Associations between visual impairment and mortality risk were estimated using Cox regression and structural equation modeling.
After 13 years, 1273 participants had died. Adjusting for mortality risk markers, higher mortality was associated with noncorrectable visual impairment (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.04-1.75). This association was stronger for ages younger than 75 years (HR, 2.58; 95% CI, 1.42-4.69). Structural equation modeling revealed greater effects of noncorrectable visual impairment on mortality risk (HR, 5.25; 95% CI, 1.97-14.01 for baseline ages <75 years), with both direct (HR, 2.16; 95% CI, 1.11-4.23) and indirect (HR, 2.43; 95% CI, 1.17-5.03) effects. Of mortality risk markers examined, only disability in walking demonstrated a significant indirect pathway for the link between visual impairment and mortality.
Visual impairment predicted mortality by both direct and indirect pathways, particularly for persons younger than 75 years with noncorrectable visual impairment. Disability in walking, which can substantially influence general health, represented a major indirect pathway.
探讨老年人视力损害与全因死亡率增加之间的途径。
蓝山眼研究在1992 - 1994年期间对3654名49岁及以上的人进行了检查（应答率82.4%），并在5年和10年后再次检查。澳大利亚国家死亡指数数据确认了截至2005年的死亡情况。视力损害根据较好眼的视力被定义为现存的、可矫正的和不可矫正的。使用Cox回归和结构方程模型估计视力损害与死亡风险之间的关联。
13年后，1273名参与者死亡。在调整死亡风险标志物后，不可矫正的视力损害与较高的死亡率相关（风险比[HR]，1.35；95%置信区间[CI]，1.04 - 1.75）。这种关联在75岁以下人群中更强（HR，2.58；95% CI，1.42 - 4.69）。结构方程模型显示不可矫正的视力损害对死亡风险的影响更大（对于基线年龄<75岁的人群，HR，5.25；95% CI，1.97 - 14.01），包括直接影响（HR，2.16；95% CI，1.11 - 4.23）和间接影响（HR，2.43；95% CI，1.17 - 5.03）。在所检查的死亡风险标志物中，只有行走障碍显示出视力损害与死亡之间联系的显著间接途径。
视力损害通过直接和间接途径预测死亡率，特别是对于75岁以下有不可矫正视力损害的人。行走障碍可对总体健康产生重大影响，是主要的间接途径。
