Cumberland Phillippa M, Rahi Jugnoo S
Life Course Epidemiology and Biostatistics Section, University College London Institute of Child Health, London, England2Ulverscroft Vision Research Group, London, England.
Life Course Epidemiology and Biostatistics Section, University College London Institute of Child Health, London, England2Ulverscroft Vision Research Group, London, England3Great Ormond Street Hospital, University College London Institute of Child Health Biomedical Research Centre, London, England4Moorfields Eye Hospital National Health Service Foundation Trust, National Institute for Health Research, Moorfields Biomedical Research Centre, London, England5University College London Institute of Ophthalmology, London, England.
JAMA Ophthalmol. 2016 Sep 1;134(9):959-66. doi: 10.1001/jamaophthalmol.2016.1778.
The adverse impact of visual impairment and blindness and correlations with socioeconomic position are known. Understanding of the effect of the substantially more common near-normal vision (mild impairment) and associations with social position as well as health and life chances is limited.
To investigate the association of visual health (across the full acuity spectrum) with social determinants of general health and the association between visual health and health and social outcomes.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional epidemiologic study was conducted using UK Biobank data from 6 regional centers in England and Wales. A total of 112 314 volunteers (aged 40-73 years) were assessed in June 2009 and July 2010. Data analysis was performed from May 20, 2013, to November 19, 2014.
Habitual (correction if prescribed) distance visual acuity was used to assign participants to 1 of 8 categories from bilateral normal visual acuity (logMAR, 0.2 or better; Snellen equivalent, 6/9.5 or better) to visual impairment or blindness (logMAR, 0.5 or worse; Snellen equivalent, 6/19 or worse) using World Health Organization and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision taxonomy. Relationships between vision, key social determinants and health and social outcomes (including the main factors that define an individual's life-the social, economic, educational, and employment opportunities and outcomes experienced by individuals during their life course) were examined using multivariable regression.
Of the of 112 314 participants, 61 169 were female (54.5%); mean (SD) age was 56.8 (8.1) years. A total of 759 (0.7%) of the participants had visual impairment or blindness, and an additional 25 678 (22.9%) had reduced vision in 1 or both eyes. Key markers of social position were independently associated with vision in a gradient across acuity categories; in a gradient of increasing severity, all-cause impaired visual function was associated with adverse social outcomes and impaired general and mental health. These factors, including having no educational qualifications (risk ratio [RR], 1.86 [95% CI, 1.69-2.04]), having a higher deprivation score (RR, 1.08 [95% CI, 1.07-1.09]), and being in a minority ethnic group (eg, Asian) (RR, 2.05 [95% CI, 1.83-2.30]), were independently associated with being in the midrange vision category (at legal threshold for driving). This level of vision was associated with an increased risk of being unemployed (RR, 1.55 [95% CI, 1.31-1.84]), having a lower-status job (RR, 1.24 [95% CI, 1.09-1.41]), living alone (RR, 1.24 [95% CI, 1.10-1.39]), and having mental health problems (RR, 1.12 [95% CI, 1.04-1.20]).
Impaired vision in adults is common, and even near-normal vision, potentially unrecognized without assessment, has a tangible influence on quality of life. Because inequalities in visual health by social position mirror other health domains, inclusion of vision in generic initiatives addressing health inequalities could address the existing significant burden of underrecognized and/or latent visual disability. Longitudinal investigations are needed to elucidate pathophysiologic pathways and target modifiable mechanisms.
视力障碍和失明的不良影响以及与社会经济地位的相关性已为人所知。对于更为常见的接近正常视力（轻度损害）的影响以及与社会地位以及健康和生活机遇的关联，人们的了解有限。
研究视觉健康（涵盖整个视力范围）与总体健康的社会决定因素之间的关联，以及视觉健康与健康和社会结局之间的关联。
设计、地点和参与者：使用来自英格兰和威尔士6个地区中心的英国生物银行数据进行了一项横断面流行病学研究。2009年6月和2010年7月对总共112314名志愿者（年龄在40 - 73岁之间）进行了评估。数据分析于2013年5月20日至2014年11月19日进行。
使用习惯性（如配镜则为矫正后）远视力，根据世界卫生组织和《国际疾病分类及相关健康问题，第十次修订本》分类法，将参与者分为8类中的1类，从双侧正常视力（对数最小分辨角，0.2或更好；Snellen视力表等效值，6/9.5或更好）到视力障碍或失明（对数最小分辨角，0.5或更差；Snellen视力表等效值，6/19或更差）。使用多变量回归研究视力、关键社会决定因素与健康和社会结局（包括定义个人生活的主要因素——个人在其生命历程中经历的社会、经济、教育和就业机会及结局）之间的关系。
在112314名参与者中，61169名是女性（54.5%）；平均（标准差）年龄为56.8（8.1）岁。共有759名（0.7%）参与者有视力障碍或失明，另外25678名（22.9%）有一只或两只眼睛视力下降。社会地位的关键指标与视力在不同视力类别中呈梯度独立相关；在严重程度增加的梯度中，全因性视觉功能受损与不良社会结局以及总体和心理健康受损相关。这些因素，包括没有学历（风险比[RR]，1.86[95%置信区间，1.69 - 2.04]）、剥夺分数较高（RR，1.08[95%置信区间，1.07 - 1.09]）以及属于少数族裔群体（如亚洲人）（RR，2.05[95%置信区间，1.83 - 2.30]），与处于中等视力类别（处于驾驶法定阈值）独立相关。这种视力水平与失业风险增加（RR，1.55[95%置信区间，1.31 - 1.84]）、工作地位较低（RR，1.24[95%置信区间，1.09 - 1.41]）、独居（RR，1.24[95%置信区间，1.10 - 1.39]）以及有心理健康问题（RR，1.12[95%置信区间，1.04 - 1.20]）相关。
成年人视力受损很常见，即使是接近正常的视力，如果不进行评估可能未被识别，也会对生活质量产生切实影响。由于社会地位导致的视觉健康不平等反映了其他健康领域的情况，将视力纳入解决健康不平等的一般性举措中，可以解决目前未被充分认识和/或潜在的视觉残疾的重大负担。需要进行纵向研究以阐明病理生理途径并针对可改变的机制。
