Sung Chieh, Chung Chi-Hsiang, Lin Fu-Huang, Chien Wu-Chien, Sun Chien-An, Tsao Chang-Huei, Weng Chih-Erh, Ng Daphne Yih
Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan.
Department of Nursing, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan.
Healthcare (Basel). 2023 May 18;11(10):1462. doi: 10.3390/healthcare11101462.
The psychosocial and health consequences of ocular conditions that cause visual impairment (VI) are extensive and include impaired daily activities, social isolation, cognitive impairment, impaired functional status and functional decline, increased reliance on others, increased risk of motor vehicle accidents, falls and fractures, poor self-rated health, and depression. We aimed to determine whether VI increases the likelihood of a poor prognosis, including mental illness, suicide, and mortality over time. In this large, location, population-based, nested, cohort study, we used data from 2000 to 2015 in the Taiwan National Health Insurance Research Database (NHIRD), which includes diagnoses of all the patients with VI. Baseline features, comorbidities, and prognostic variables were evaluated using a 1:4-matched cohort analysis. Furthermore, comparisons were performed using Cox regression and Bonferroni-correction (for multiple comparisons) to study the association between VI and poor prognosis (mental illness, suicide). The study outcome was the cumulative incidence of poor prognosis among the visually impaired and controls. A two-tailed Bonferroni-corrected < 0.001 was considered statistically significant. Among the 1,949,101 patients enlisted in the NHIRD, 271 had been diagnosed with VI. Risk factors for poor prognosis and the crude hazard ratio was 3.004 (95% confidence interval 2.135-4.121, < 0.001). Participants with VI had an increased risk of poor prognosis according to the sensitivity analysis, with a poor prognosis within the first year and first five years. VI was associated with suicide and mental health risks. This study revealed that patients with VI have a nearly 3-fold higher risk of psychiatric disorders, including anxiety, depression, bipolar, and sleep disorders, than the general population. Early detection through comprehensive examinations based on increased awareness in the clinical context may help maintain visual function and avoid additional complications.
导致视力损害（VI）的眼部疾病所带来的心理社会和健康后果广泛，包括日常活动受损、社会隔离、认知障碍、功能状态受损和功能衰退、对他人的依赖增加、机动车事故、跌倒和骨折风险增加、自我评估健康状况不佳以及抑郁。我们旨在确定随着时间推移，视力损害是否会增加不良预后的可能性，包括精神疾病、自杀和死亡。在这项大规模、基于地点、以人群为基础的嵌套队列研究中，我们使用了2000年至2015年台湾国民健康保险研究数据库（NHIRD）中的数据，该数据库包含所有视力损害患者的诊断信息。使用1:4匹配队列分析评估基线特征、合并症和预后变量。此外，使用Cox回归和Bonferroni校正（用于多重比较）进行比较，以研究视力损害与不良预后（精神疾病、自杀）之间的关联。研究结果是视力受损者和对照组中不良预后的累积发生率。双尾Bonferroni校正<0.001被认为具有统计学意义。在NHIRD登记的1,949,101名患者中，271人被诊断为视力损害。不良预后的危险因素和粗危险比为3.004（95%置信区间2.135 - 4.121，<0.001）。根据敏感性分析，视力损害参与者在第一年和前五年内出现不良预后的风险增加。视力损害与自杀和心理健康风险相关。这项研究表明，视力损害患者患精神疾病（包括焦虑、抑郁、双相情感障碍和睡眠障碍）的风险比普通人群高近3倍。在临床环境中提高认识，通过全面检查进行早期检测，可能有助于维持视觉功能并避免额外并发症。
