Blindness and Visual Impairment in the Medicare Population: Disparities and Association with Hip Fracture and Neuropsychiatric Outcomes
Blindness and Visual Impairment in the Medicare Population: Disparities and Association with Hip Fracture and Neuropsychiatric Outcomes
复制标题
DOI：
10.1080/09286586.2019.1611879
复制
发表时间：
2019-05-08
影响因子：
1.8
通讯作者：
Willis, Allison W.
中科院分区：
文献类型：
--
作者：
Hamedani, Ali G.;VanderBeek, Brian L.;Willis, Allison W.
目的：视力丧失与负面健康结果相关，但缺乏关于视力丧失的人口水平数据，并且关于妇女、少数民族和老年群体的低视力相关结果的数据有限。本研究的目的是确定视力丧失在美国老年人中具有全国代表性的患病率，并研究其与髋部骨折、抑郁、焦虑和痴呆的关系。方法：对2014年医疗保险索赔数据进行横断面分析。使用基于ICD-9和CPT代码的慢性病仓库指标变量来识别失明和低视力、髋部骨折、抑郁、焦虑和痴呆。建立多变量logistic回归模型来检验社会人口因素是否与视力丧失相关，并确定视力丧失与髋部骨折和神经精神预后之间的关系。结果：低视力在医保人群中的患病率为994/10万，并随着年龄、黑人（1854 /10万）或西班牙裔（2862 /10万）、种族/民族、女性（1181 /10万）和医疗补助资格（2975 /10万）的增加而显著增加。在校正相关合并症后，低视力与髋部骨折（调整优势比[AOR] 2.54, 95% CI: 2.52-2.57）、抑郁（AOR 3.99, 95% CI: 3.97-4.01）、焦虑（AOR 2.93, 95% CI: 2.91-2.95）和痴呆（AOR 3.91, 95% CI: 3.88-3.93）显著相关。结论：失明和低视力在美国老年人中很常见，尤其是在少数种族和低收入人群中，并与髋部骨折、抑郁、焦虑和痴呆有关。预防和治疗视力丧失可以减少老龄化人口的健康差距和负面健康结果。
Purpose: Vision loss has been associated with negative health outcomes, but population-level data on vision loss are lacking, and there are limited data on low vision-associated outcomes among women, minorities, and older age groups. The objective of this study was to determine the prevalence of vision loss in a nationally representative sample of older US adults and examine its association with hip fracture, depression, anxiety, and dementia. Methods: Cross-sectional analysis of Medicare claims data from 2014. Blindness and low vision, hip fracture, depression, anxiety, and dementia were identified using Chronic Condition Warehouse indicator variables based on ICD-9 and CPT codes. Multivariable logistic regression models were built to examine whether sociodemographic factors were associated with vision loss and to determine the relationships between vision loss and hip fracture and neuropsychiatric outcomes. Results: The prevalence of low vision in the Medicare population was 994/100,000 and increased significantly with age, Black (1,854/100,000) or Hispanic (2,862/100,000) race/ethnicity, female gender (1,181/100,000), and Medicaid eligibility (2,975/100,000). After adjusting for relevant comorbidities, low vision was significantly associated with hip fracture (adjusted odds ratio [AOR] 2.54, 95% CI: 2.52-2.57), depression (AOR 3.99, 95% CI: 3.97-4.01), anxiety (AOR 2.93, 95% CI: 2.91-2.95), and dementia (AOR 3.91, 95% CI: 3.88-3.93). Conclusion: Blindness and low vision are common in older Americans, especially among racial and ethnic minorities and lower income individuals, and associated with hip fracture, depression, anxiety, and dementia. The prevention and treatment of vision loss may reduce health disparities and negative health outcomes in the aging population.