Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
Department of Human Development and Family Studies and Statistics, Purdue University, West Lafayette, Indiana.
JAMA Ophthalmol. 2020 Apr 1;138(4):387-394. doi: 10.1001/jamaophthalmol.2020.0052.
Visual impairment and visual disorders often co-occur with other chronic conditions. Understanding patterns of multimorbidity is important for reducing health care use and improving health outcomes.
To identify chronic condition patterns and their association with visual impairment and health care use in a nationally representative sample.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used National Health Interview Survey data for 387 780 individuals aged 18 years and older, representative of the civilian noninstitutionalized US population, from January 1, 2002, to December 31, 2014. Statistical analysis was performed from June to November 2018.
Participants were classified in subgroups with different combinations of self-reported chronic conditions using latent class analysis.
Self-reported visual impairment, emergency department visit, and hospitalization use in the previous 12 months.
Among the 387 780 individuals included in the study, 51.8% were female, 77.6% were white, and the mean (SD) age was 46.2 (18.0) years. Latent class analysis identified 5 different classes, with 70.5% of the participants belonging to the healthy group. The other 4 groups represented various degrees and patterns of multimorbidity. The hypertensive group (19.6%) had a high prevalence of hypertension (62.6%), the respiratory conditions group (4.4%) had a high prevalence of emphysema (47.7%) and asthma (45.6%), the heart disease group (3.6%) had high prevalence of coronary heart disease (69.8%), and the severely impaired group (1.8%) had higher prevalence of most conditions compared with the other groups. In the adjusted analysis, compared with the healthy group, participants in all 4 disease groups had elevated risk of visual impairment: heart condition group (odds ratio [OR], 3.19; 95% CI, 2.92-3.48), hypertensive group (OR, 3.28; 95% CI, 3.10-3.48), respiratory condition group (OR, 3.87; 95% CI, 3.56-4.20), and severely impaired group (OR, 10.19; 95% CI, 9.20-11.28). All 4 disease groups had elevated risk of reporting emergency department use and hospitalization. For the severely impaired group, the OR for emergency department use was 9.39 (95% CI, 8.53-10.34), and the OR for hospitalization was 10.80 (95% CI, 9.80-11.92).
In this study, individuals in all 4 multimorbidity groups had an elevated risk of visual impairment and health care use compared with the healthy group. Characteristics of high-risk groups identified by this study may help in the development and implementation of interventions to avert the more serious consequences of having multiple chronic conditions.
视力障碍和视觉障碍通常与其他慢性疾病同时发生。了解多病症模式对于减少医疗保健的使用和改善健康结果非常重要。
在具有全国代表性的样本中确定慢性疾病模式及其与视力障碍和医疗保健使用之间的关系。
设计、地点和参与者：本横断面研究使用了美国国家健康访谈调查 2002 年 1 月 1 日至 2014 年 12 月 31 日期间的 387780 名 18 岁及以上的，代表非机构化的美国平民人口的个人的数据。统计分析于 2018 年 6 月至 11 月进行。
参与者根据使用潜在类别分析的自我报告的慢性疾病的不同组合分为亚组。
报告的在过去 12 个月内视力障碍、急诊就诊和住院治疗的情况。
在纳入研究的 387780 名参与者中，51.8%为女性，77.6%为白人，平均（标准差）年龄为 46.2（18.0）岁。潜在类别分析确定了 5 种不同的类别，其中 70.5%的参与者属于健康组。其他 4 组代表了不同程度和模式的多病症。高血压组（19.6%）的高血压患病率很高（62.6%），呼吸疾病组（4.4%）的肺气肿和哮喘患病率很高（分别为 47.7%和 45.6%），心脏病组（3.6%）的冠心病患病率很高（69.8%），与其他组相比，严重受损组的大多数疾病的患病率更高。在调整后的分析中，与健康组相比，所有 4 种疾病组的视力障碍风险均升高：心脏病组（比值比[OR]，3.19；95%置信区间[CI]，2.92-3.48）、高血压组（OR，3.28；95%CI，3.10-3.48）、呼吸状况组（OR，3.87；95%CI，3.56-4.20）和严重受损组（OR，10.19；95%CI，9.20-11.28）。所有 4 种疾病组都有更高的急诊就诊和住院治疗风险。对于严重受损组，急诊就诊的 OR 为 9.39（95%CI，8.53-10.34），住院治疗的 OR 为 10.80（95%CI，9.80-11.92）。
在这项研究中，与健康组相比，所有 4 个多病症组的视力障碍和医疗保健使用风险均升高。本研究确定的高风险组的特征可能有助于制定和实施干预措施，以避免患有多种慢性疾病的更严重后果。
