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

项目摘要/摘要 美国至少有1400万人失明或患有视力障碍(VI)，而这一数字 由于老龄化和美国人口的增长，预计到2050年，受影响的人口将翻一番。大多数人 患有VI和失明的人中有65岁的≥老年人。种族和少数民族也是 受影响不成比例，部分原因是健康的社会决定因素(SDoH)，如医疗保健 通道、经济稳定性和建成环境的特点。特别是在晚年，人们认为VI 与一系列不良后果有关，包括痴呆症、接受长期护理 设施，甚至是死亡率。尽管如此，对SDoH如何影响的严谨和可推广的研究 视力和眼睛健康，以及视力如何影响晚年结果，由于缺乏 数据：(I)是纵向的；(Ii)代表美国人口；(Iii)包含客观数据 对视觉功能的评估；以及(Iv)对老年人进行抽样。在拟议的项目中，我们将 使用NIH资助的国家健康和老龄化中心新收集的视力数据来解决这一障碍 趋势研究(NHATS)，这是一个正在进行的具有全国代表性的小组研究，对象是7,000名年龄在≥65岁的成年人 好几年了。2021年，NHATS开始每年测量距离和近视力和对比度 敏感度。在拟议研究的目标1中，我们使用NHATS数据来提供有史以来第一次关于 国家一级的VI发病率和盲目率以及全国流行率估计 按年龄、性别、种族和民族分层。在目标2中，我们将评估 SDoH谈视力健康。为此，我们将利用NHATS的SDoH个人水平指标，以及 邻里级别-来自NIH资助的国家邻里数据档案馆的指标 致NHATS。在目标3中，我们将调查VI和失明对 痴呆症的发展、长期护理的安置和各种原因造成的死亡。在子目标中，我们将 使用纵向中介模型检验SDoH对不良晚年生活的影响 结果受视力和眼睛健康的影响。到目前为止，还无法进行 关于维生素I与SDoH相关性和关键晚年结局的全国性代表性研究 由于缺乏国家样本中纵向和客观测量的视觉功能数据。因此， 拟议的研究将解决关键的科学差距。这项提议也高度响应了 国家眼科研究所新的五年战略计划，包括：(I)收集当前的流行病学数据； (Ii)支持在SDoH和医疗保健系统的结合点进行研究；以及(Iii)探索研究 包括合并症。流行病学估计将公之于众，所有研究 研究结果将被广泛传播，以最大限度地发挥这些研究对公众健康和 政策，并为老龄化的美国人口优化视野和整体健康和福祉。

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.