Vision Impairment in the National Health and Aging Trends Study: Epidemiology, Social Determinants of Health, and Adverse Late Life Outcomes

国家健康和老龄化趋势研究中的视力障碍：流行病学、健康的社会决定因素和不良的晚年结局

• 批准号: 10730418
• 负责人: Joshua Robert Ehrlich
• 金额: $ 66.16万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10730418
• 关键词: Address; Admission activity; Adopted; Adult; Affect; Aged, 80 and over; Aging; Black Populations; Blindness; Collaborations; Complement; Complex; Contrast Sensitivity; Data; Dementia; Development; Diagnosis; Economics; Elderly; Epidemiology; Ethnic Origin; Ethnic Population; Eye; Eye diseases; Funding; Growth; Health; Health care facility; Healthcare Systems; Hispanic Populations; Impairment; Incidence; Individual; Link; Long-Term Care; Measurement; Measures; Mediating; Mediation; Medicare; Medicare claim; Mission; Modeling; National Eye Institute; Neighborhoods; Outcome; Personal Satisfaction; Persons; Policies; Population; Prevalence; Protocols documentation; Public Health; Public Policy; Race; Reporting; Research; Research Personnel; Research Support; Risk Factors; Sample Size; Sampling; Strategic Planning; Surveys; System; Testing; Time; United States National Institutes of Health; Validation; Vision; Vision Tests; Visual; Visual Acuity; Visual impairment; Work; adverse outcome; age group; age stratification; beneficiary; blind; built environment; comorbidity; contextual factors; data archive; demographics; disability; dissemination strategy; epidemiologic data; ethnic minority; experience; health care availability; health disparity; health equity; human old age (65+); insight; interest; longitudinal analysis; mortality; novel; population based; prospective; racial minority; racial minority population; sex; social health determinants; social media; socioeconomics; symposium; trend

PROJECT SUMMARY/ABSTRACT At least 14 million people in the U.S. are blind or living with a vision impairment (VI), and the number affected is projected to double by 2050 due to aging and growth of the U.S. population. The majority of those with VI and blindness are older adults aged ≥65 years. Racial and ethnic minorities are also disproportionately affected, in part due to social determinants of health (SDoH) like healthcare access, economic stability, and features of the built environment. Particularly in later life, VI is thought to be associated with a host of adverse outcomes, including dementia, admission to a long-term care facility, and even mortality. Nonetheless, rigorous and generalizable research on how SDoH impact vision and eye health, and how vision influences late-life outcomes has been limited due to a lack of data that: (i) is longitudinal; (ii) is representative of the U.S. population; (iii) contains objective assessments of visual function; and (iv) samples older adults. In the proposed project, we will address this barrier using newly collected vision data from the NIH-funded National Health and Aging Trends Study (NHATS), an ongoing nationally representative panel study of >7,000 adults aged ≥65 years. In 2021, NHATS began annual measurement of distance and near visual acuity and contrast sensitivity. In Aim 1 of the proposed study, we use NHATS data to provide the first-ever estimates on the incidence of VI and blindness at the national level, as well as national prevalence estimates stratified by age, sex, and race and ethnicity. In Aim 2, we will evaluate the longitudinal influence of SDoH on vision health. To do so, we will utilize individual-level indicators of SDoH from NHATS, and neighborhood level-indicators from the NIH-funded National Neighborhood Data Archive that is linked to NHATS. In Aim 3, we will investigate the longitudinal impact of VI and blindness on the development of dementia, placement in long-term care, and all-cause mortality. In a sub-aim, we will use a longitudinal mediation model to test whether the influence of SDoH on adverse late-life outcomes is mediated by vision and eye health. To date, it has not been possible to carry out nationally representative studies on the associations of VI with SDoH and key late-life outcomes due to the lack of longitudinal and objectively measured visual function data in a national sample. Thus, the proposed studies will address critical scientific gaps. This proposal is also highly responsive to the National Eye Institute’s new 5-year Strategic Plan, including: (i) to gather current epidemiologic data; (ii) to support research at the nexus of SDoH and the healthcare system; and (iii) to explore research encompassing comorbidities. Epidemiological estimates will be made publicly available and all study findings will be widely disseminated to maximize the impact of these studies on public health and policy and to optimize vision and overall health and wellbeing for an aging U.S. population.

项目摘要/摘要 美国至少有1400万人是盲人或视力障碍（VI），数量 由于美国人口的衰老和增长，预计到2050年，受影响将翻一番。多数 在VI和失明的人中，年龄≥65岁的老年人。种族和少数民族也是 不成比例的影响，部分原因是医疗保健等卫生的社会决定者（SDOH） 访问，经济稳定和建筑环境的特征。特别是在以后的生活中，VI被思考 与许多不良后果有关，包括痴呆症，接受长期护理 设施，甚至死亡率。尽管如此，关于SDOH如何影响 视力和眼睛健康，以及视力如何影响晚期的结果，由于缺乏 数据：（i）是纵向的； （ii）是美国人口的代表； （iii）包含目标 评估视觉功能； （iv）样品老年人。在拟议的项目中，我们将 使用NIH资助的国家健康和衰老的新收集的愿景数据来解决此障碍 趋势研究（NHATS），一项持续的全国代表性小组研究，> 7,000名成年人≥65岁 年。在2021年，NHATS开始年度测量距离和近似视力和对比度 灵敏度。在拟议的研究的AIM 1中，我们使用NHATS数据提供了有史以来的首次估计 国家一级的VI和失明事件以及国家患病率估计 按年龄，性别，种族和种族分层。在AIM 2中，我们将评估 SDOH关于视力健康。为此，我们将利用NHATS的SDOH的个人级指标，以及 NIH资助的国家邻里数据档案存档中的邻里水平调查员 到NHATS。在AIM 3中，我们将研究VI和失明对 痴呆症的发展，长期护理中的安置以及全因死亡率。在一个子aim中，我们将 使用纵向调解模型测试SDOH对不良后期的影响 结果是由视力和眼睛健康介导的。迄今为止，不可能进行 关于VI与SDOH和关键的晚期结局的全国代表性研究 在国家样本中缺乏纵向和客观测量的视觉功能数据。那， 拟议的研究将解决关键的科学差距。该提议也对 国家眼科研究所的新的5年战略计划，包括：（i）收集当前的流行病学数据； （ii）支持SDOH和医疗保健系统Nexus的研究； （iii）探索研究 包括合并症。流行病学估计将公开可用，所有研究 调查结果将被广泛传播，以最大化这些研究对公共卫生和 政策，以优化美国老年人口的远见，整体健康和福祉。