Health Disparities in Visually Impaired Adults with Multimorbidity

 描述（由申请人提供）：视力障碍（VI）与生产力降低、生活质量降低和死亡率增加有关。患有VI的人不能从事某些类型的工作，受到驾驶限制，并且受伤的风险增加。等 限制可以直接影响身心健康状况，降低社会功能，减少劳动力的参与。众所周知，VI是老年人经常面临的最致残的慢性疾病之一。人们对发病率和死亡率可能产生的协同影响知之甚少，当人们必须与VI生活在一起时，除了其他慢性致残性疾病，以及这些影响如何不同地影响重要的利益亚组，如少数民族人口。为了更好地了解有和没有其他慢性健康状况的视障者的健康差异如何与社会劣势协同作用，这项研究将利用来自国家健康访谈调查（NHIS）和医疗费用专门小组调查（MEPS）的数据，以确定视力受损的亚群，这些亚群也患有各种共病，并可能遭受视力损害（相对于一般人口）的发病率和死亡率。一旦确定，就死亡风险而言，VI和合并症的最毒性组合将使用可用的高级统计建模技术进行分类和排名。然后，本研究将使用这些新表征的“高死亡风险”亚群来指导我们对质量调整生命年（QHMS）差异的分析，QHMS是一种将疾病的发病率和死亡率结合到一个单一指标中的方法，该指标表示个体剩余的最佳健康年数（即健康调整预期寿命）。这项拟议中的研究将增加人们对视力障碍对健康和寿命的不利影响的理解，这种影响可能被低估了。此外，这项研究的结果将为临床医生和政策制定者提供有关复杂疾病模式（VI加上共同发生的条件）的新信息，然后可用于识别和干预极高风险人群。这些研究目的支持国家眼科研究所（NEI）眼流行病学战略规划报告的关键目标，其中包括：（1）确定不断变化的人群中眼病的负担及其视力结果;（2）开发新的方法来支持眼科流行病学研究。14拟议的研究还支持疾病预防控制中心和NEI改善视力相关人群健康的倡议，包括识别与VI相关的增加残疾的合并症。

 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.