Association of Vision Impairment With Preventive Care Use Among Older Adults in the United States
Association of Vision Impairment With Preventive Care Use Among Older Adults in the United States
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DOI：
10.1001/jamaophthalmol.2020.4524
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发表时间：
2020-10-29
影响因子：
8.1
通讯作者：
Swenor, Bonnielin K.
中科院分区：
文献类型：
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作者：
Assi, Lama;Varadaraj, Varshini;Swenor, Bonnielin K.
本研究探讨自我报告的视力障碍和预防保健服务（即乳腺癌和结肠癌筛查和流感和肺炎球菌疫苗接种）之间的关联。问题视力障碍和预防保健使用之间的关联是什么美国居民50岁及以上？结果在这项横断面研究中，那些自我报告的视力障碍不太可能报告乳腺癌和结肠癌筛查比那些没有视力障碍。然而，根据视力损害状况报告流感疫苗和肺炎球菌疫苗的几率没有差异。意义虽然这项调查不能确定视力障碍是否影响预防保健，这些结果表明，美国老年人视力障碍可能不太可能使用预防保健服务，并强调有机会改善医疗保健使用这一group.Importance预防保健与老年人发病率和死亡率下降。视力障碍可能是获得护理和健康促进信息的障碍，因此可能导致预防性护理的减少。目的研究自我报告的视力损害与预防保健服务（即乳腺癌和结肠癌筛查以及流感和肺炎球菌疫苗接种）之间的关系。设计，设置和参与者使用2015年和2018年全国健康访谈调查（NHIS）以及2016年和2018年行为风险因素监测系统（BRFSS）数据的横断面研究，通过NHIS中的亲自家庭访谈对美国居民进行的全国性调查，以及BRFSS中基于州的电话访谈。参与者包括50岁及以上的受访者，根据每个预防保健服务检查的资格。视力损害，在NHIS中定义为自我报告的视力障碍，在BRFSS中定义为自我报告的失明/严重视力障碍。主要结果和测量自我报告的乳腺癌筛查（50-74岁的女性），结肠癌筛查（50-74岁），流感疫苗接种（50岁及以上）和肺炎球菌疫苗接种（65岁及以上）。调整相关混杂因素（包括年龄）的多变量回归模型用于检查视力障碍状态对每种预防保健服务的摄取。结果在NHIS参与者中，视力受损的美国老年人（不同年龄组的患病率为14.3%-16.3%; n = 12120 - 29654）报告乳腺癌筛查的可能性较小（比值比[OR]，0.82; 95% CI，0.71-0.96）和结肠癌筛查（OR，0.89; 95% CI，0.79-0.99）但不是流感（OR，1.06; 95%CI，0.97-1.15）和肺炎球菌疫苗接种（OR，1.03; 95%CI，0.91-1.16）与无视力障碍的同行相比。在BRFSS（n = 228 649-530 027），视力受损者（5.9%-6.8%）比无视力障碍者报告乳腺癌筛查的可能性低（OR，0.67; 95% CI，0.59-0.75），结肠癌筛查（OR，0.70; 95%CI，0.65-0.76）和肺炎球菌疫苗接种（OR，0.89; 95%CI，0.81-0.99），但不是流感疫苗接种（OR，0.95; 95%CI，0.89-1.00）。结论和相关性与视力障碍的美国老年人可能不太可能使用癌症相关的预防服务相比，他们的同行没有视力障碍。这些研究结果表明，可能需要采取干预措施，改善视力障碍者获得健康信息和医疗保健服务的机会，以改善这一人群的癌症筛查。
This study examines the association between self-reported vision impairment and uptake of preventive care services (ie, breast and colon cancer screenings and influenza and pneumococcal vaccinations).Question What is the association between vision impairment and preventive care use among US residents 50 years and older? Findings In this cross-sectional study, those with self-reported vision impairment were less likely to report breast and colon cancer screening than those without vision impairment. However, there was no difference in the odds of reporting influenza and pneumococcal vaccines by vision impairment status. Meaning While this investigation cannot determine whether vision impairment affects preventive care, these results suggest that older US individuals with vision impairment may be less likely to use preventive care services and highlight an opportunity to improve health care use for this group.Importance Preventive care is associated with decreased morbidity and mortality among older adults. Vision impairment may be a barrier to accessing care and health promotion information and therefore may contribute to decreased preventive care uptake. Objective To examine the association between self-reported vision impairment and uptake of preventive care services (ie, breast and colon cancer screenings and influenza and pneumococcal vaccinations). Design, Setting, and Participants Cross-sectional study using the 2015 and 2018 National Health Interview Survey (NHIS) and 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) data, national surveys of US residents conducted through in-person household interviews in NHIS, and state-based telephone interviews in BRFSS. Participants included respondents 50 years and older based on eligibility for each preventive care service examined. Exposures Vision impairment, defined as self-reported trouble seeing, in NHIS, and self-reported blindness/serious difficulty seeing in BRFSS. Main Outcomes and Measures Self-reported uptake of breast cancer screening (women aged 50-74 years), colon cancer screening (aged 50-74 years), influenza vaccination (50 years and older), and pneumococcal vaccination (65 years and older). Multivariable regression models adjusted for relevant confounders, including age, were used to examine the uptake of each preventive care service by vision impairment status. Results Among NHIS participants, older US individuals with vision impairment (prevalence between 14.3% and 16.3% in the different age groups; n = 12 120-29 654) were less likely to report breast cancer screening (odds ratio [OR], 0.82; 95% CI, 0.71-0.96) and colon cancer screening (OR, 0.89; 95% CI, 0.79-0.99) but not influenza (OR, 1.06; 95% CI, 0.97-1.15) and pneumococcal vaccination (OR, 1.03; 95% CI, 0.91-1.16), as compared with their counterparts without vision impairment. In BRFSS (n = 228 649-530 027), those with vision impairment (5.9%-6.8%) were less likely than those without vision impairment to report breast cancer screening (OR, 0.67; 95% CI, 0.59-0.75), colon cancer screening (OR, 0.70; 95% CI, 0.65-0.76), and pneumococcal vaccination (OR, 0.89; 95% CI, 0.81-0.99) but not influenza vaccination (OR, 0.95; 95% CI, 0.89-1.00). Conclusions and Relevance Older Americans with vision impairment may be less likely to use cancer-related preventive services as compared with their counterparts without vision impairments. These findings suggest that interventions to improve access to health information and health care services for individuals with vision impairment may be needed to improve cancer screening among this population.