Health Disparities in Visually Impaired Adults with Multimorbidity



 DESCRIPTION (provided by applicant): Visual impairment (VI) is associated with lower productivity, poorer quality of life, and greater mortality. People with VI cannot perform certain types of jobs, are subject to driving restrictions, and are at an increased risk for injuries. Such limitations can directly affect both physical and mental health status, reduce social functioning, and reduce participation in the labor force. It is well known that VI is among the most disabling chronic conditions which older adults often face. Less is known about possible synergistic impacts on morbidity and mortality when persons must live with VI in addition to other chronic disabling conditions and how these impacts may differentially affect important subgroups of interest such as minority populations. To better understand how health disparities synergize with social disadvantages among the visually impaired with and without other chronic health conditions, this study will utilize data from the National Health Interview Survey (NHIS) and the Medical Expenditure Panel Survey (MEPS) to identify visually impaired subpopulations who are also living with various co-morbid conditions and who may suffer disproportionally (relative to the general population) in terms of morbidity and mortality. Once identified, the most toxic combinations of VI and co- morbidities in terms of mortality risk will be categorized and ranked using advanced statistical modeling techniques available. This study will then use these newly characterized "high mortality risk" subpopulations to guide our analyses of differences in quality adjusted life years(QALYS), a measure which combines the morbidity and mortality of disease into a single metric expressing the number of years of optimal health an individual has remaining (i.e. health adjusted life expectancy). The proposed research will increase the understanding of the detrimental impact that visual impairment has on health and longevity which may have underestimated. In addition, results from this research will provide clinicians and policy makers with novel information regarding complex disease patterns (VI plus co-occurring conditions), which can then be used to identify and intervene in extremely high risk populations. These study aims support key goals of the National Eye Institute (NEI) ocular epidemiology strategic planning report, which include: (1) Determine the burden of eye diseases and their visual outcomes in a changing population, and; (2) Develop new methodologies to support ophthalmic epidemiological research.14 The proposed research also supports the CDC and NEI initiatives for improving vision--related population health, including the identification o comorbidities associated with VI that increase disability.