Visual acuity change and mortality in older adults
Visual acuity change and mortality in older adults
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DOI：
10.1167/iovs.05-0687
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发表时间：
2005-11-01
影响因子：
4.4
通讯作者：
Rubin, G
中科院分区：
文献类型：
--
作者：
Freeman, EE;Egleston, BL;Rubin, G
目的.一些研究表明，老年人视力障碍的死亡率增加，但很少有人试图解决潜在的因果机制。本研究的目的是确定视力丧失是否会增加死亡风险，并检查抑郁症状是否在这种关系中起中介作用。数据来自2520名参与索尔兹伯里眼科评估项目的老年人，这是一项基于人群的前瞻性8年队列研究。采用早期治疗糖尿病视网膜病变研究[ETDRS]视力表测量双眼视力，采用一般健康问卷D部分分量表测量抑郁症状。通过工作人员随访收集死亡率数据。采用考克斯比例风险回归进行分析。基线视力差与较高的死亡率相关（风险比[HR] = 1.05; 95%置信区间[CI]，1.01 - 1.09）。此外，那些在2年内获得两行或更多行视力的人有较低的调整后死亡风险（HR = 0.47; 95%CI，0.23 - 0.95）。在2年内视力丧失≥ 3行的女性有更高的调整后死亡风险（HR = 3.97; 95%CI，2.21 - 7.15），而男性则没有（HR = 1.32; 95%CI，0.66 - 2.63）。抑郁症状并不介导这些关系。如果视力和死亡率之间的关系确实是因果关系，那么它很可能通过各种干预变量通过许多途径起作用。如果视力不能恢复，这些干预变量的识别可以提供额外的干预目标。
PURPOSE. Several studies indicate an increased mortality rate in older adults who have visual impairment, but few have attempted to address a potential causal mechanism. The goals of this study are to determine whether visual acuity loss increases the risk of dying and to examine whether depressive symptoms act as a mediator in this relationship.METHODS. Data were derived from the 2520 older adults who participated in the Salisbury Eye Evaluation project, a population-based prospective 8-year cohort study. Presenting binocular visual acuity was measured with the Early Treatment Diabetic Retinopathy Study [ETDRS] eye chart and depressive symptoms with the General Health Questionnaire Part D subscale. Mortality data were collected by staff follow-up. Analyses were performed with the Cox proportional hazards regression.RESULTS. Worse baseline acuity was associated with a higher mortality rate ( hazard ratio [HR] = 1.05; 95% confidence interval [CI], 1.01 - 1.09). Also, those who gained two or more lines of visual acuity over 2 years had a lower adjusted risk of dying ( HR = 0.47; 95% CI, 0.23 - 0.95). An interaction was detected, in that women who lost >= 3 lines of visual acuity over a 2-year period had a higher adjusted risk of dying ( HR = 3.97; 95% CI, 2.21 - 7.15), whereas men did not ( HR = 1.32; 95% CI, 0.66 - 2.63). Depressive symptoms did not mediate these relationships.CONCLUSIONS. If the relationship between visual acuity and mortality is indeed causal, it most likely acts via numerous pathways through a variety of intervening variables. The identification of these intervening variables could give additional targets for intervention if acuity cannot be restored.