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

项目总结/摘要 在美国，至少有1400万人失明或患有视力障碍（VI）， 预计到2050年，由于美国人口的老龄化和增长，受影响的人口将翻一番。大多数 VI和失明患者中有65岁以上的老年人。种族和少数民族也是 不成比例地受到影响，部分原因是健康的社会决定因素（SDoH），如医疗保健 访问，经济稳定性和建筑环境的特点。尤其是在晚年， 与一系列不良后果有关，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年的结果一直是有限的，由于缺乏 数据：（i）纵向;（ii）代表美国人口;（iii）包含客观的 视觉功能的评估;和（iv）老年人的样本。在拟议项目中，我们将 利用NIH资助的国家健康与老龄化研究所新收集的视力数据来解决这一障碍 趋势研究（NHATS），一项正在进行的全国代表性小组研究，涉及> 7，000名年龄≥65岁的成年人 年2021年，NHATS开始每年测量远、近视力和对比度 灵敏度在拟议研究的目标1中，我们使用NHATS数据首次估计了 国家一级VI和失明的发病率以及国家流行率估计数 按年龄、性别、种族和民族分层。在目标2中，我们将评估 SDoH关于视力健康。为此，我们将利用NHATS中的SDoH个人水平指标， 邻里水平-来自NIH资助的国家邻里数据档案馆的指标， 关于NHATS在目标3中，我们将调查VI和失明对 痴呆症的发展、长期护理和全因死亡率。在子目标中，我们将 使用纵向中介模型来检验SDoH对不良晚年生活的影响 结果是由视力和眼睛健康介导的。到目前为止，还无法执行 关于VI与SDoH和关键晚年结局之间关系的全国代表性研究， 缺乏全国样本中纵向和客观测量的视觉功能数据。因此，在本发明中， 拟议的研究将解决关键的科学差距。这一建议也是高度响应 国家眼科研究所新的5年战略计划，包括：（i）收集当前的流行病学数据; (ii)支持有关部门卫生署与医疗系统关系的研究;及（iii）探讨研究 包括合并症。流行病学估计数将公开提供，所有研究 研究结果将广泛传播，以最大限度地扩大这些研究对公共卫生的影响， 政策，并优化美国老龄化人口的愿景和整体健康和福祉。

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.