Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; University of Michigan Center for Disability Health and Wellness, Ann Arbor, MI, USA.
Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; University of Michigan Center for Disability Health and Wellness, Ann Arbor, MI, USA.
Disabil Health J. 2023 Jan;16(1):101371. doi: 10.1016/j.dhjo.2022.101371. Epub 2022 Aug 29.
Vision impairment (VI) affects approximately 1 in 28 Americans over the age of 40 and the prevalence increases sharply with age. However, experiencing vision loss with aging can be very different from aging with VI acquired earlier in life. People aging with VI may be at increased risk for diabetes due to environmental barriers in accessing health care, healthy food, and recreational resources that can facilitate positive health behaviors.
This study examined the relationship between neighborhood characteristics and incident type 2 diabetes mellitus (T2DM) among a cohort of 22,719 adults aging with VI.
Data are from Optum® Clinformatics® DataMart, a private administrative claims database (2008-2017). Individuals 18 years of age and older at the time of their initial VI diagnosis were eligible for analysis. VI was determined using vision impairment, low vision, and blindness codes (ICD-9-CM, ICD-10-CM). Covariates included age, sex, and comorbidities. Cox models estimated adjusted hazard ratios (HRs) for incident T2DM. Stratified models examined differences in those aging with (age 18-64) and aging into (age 65+) vision impairment.
Residence in neighborhoods with greater intersection density (HR = 1.26) and high-speed roads (HR = 1.22) were associated with increased risk of T2DM among older adults with VI. Living in neighborhoods with broadband internet access (HR = 0.67), optical stores (HR = 0.62), supermarkets (HR = 0.78), and gyms/fitness centers (HR = 0.63) was associated with reduced risk of T2DM for both younger and older adults with VI.
Findings emphasize the importance of neighborhood context for mitigating the adverse consequences of vision loss for health.
视力障碍（VI）影响大约每 28 个 40 岁以上的美国人中的 1 人，且随着年龄的增长患病率急剧上升。然而，随着年龄的增长而出现视力下降的情况与早年因 VI 而导致的衰老有很大的不同。随着 VI 衰老的人由于在获得医疗保健、健康食品和娱乐资源方面存在环境障碍，可能会增加患糖尿病的风险，这些障碍会促进积极的健康行为。
本研究调查了 22719 名 VI 成年患者队列中，邻里特征与 2 型糖尿病（T2DM）发病之间的关系。
数据来自 Optum® Clinformatics® DataMart，这是一个私人行政索赔数据库（2008-2017 年）。在初次 VI 诊断时年满 18 岁的个人有资格进行分析。VI 通过视力障碍、低视力和失明代码（ICD-9-CM、ICD-10-CM）确定。协变量包括年龄、性别和合并症。Cox 模型估计了 T2DM 发病的调整后的危险比（HR）。分层模型研究了在 VI 发病年龄（18-64 岁）和 VI 发病后年龄（65 岁以上）的人群中差异。
居住在交叉口密度较大（HR=1.26）和高速路（HR=1.22）较多的邻里地区与 VI 老年患者 T2DM 的发病风险增加相关。居住在宽带互联网接入（HR=0.67）、眼镜店（HR=0.62）、超市（HR=0.78）和健身房/健身中心（HR=0.63）较多的邻里地区与 VI 年轻和老年患者的 T2DM 发病风险降低相关。
研究结果强调了邻里环境对减轻视力丧失对健康的不利影响的重要性。
