Health Disparities in Visually Impaired Adults with Multimorbidity

 描述(由申请人提供)：视力障碍(VI)与较低的生产力、较差的生活质量和较高的死亡率有关。患有VI的人不能从事某些类型的工作，受到驾驶限制，受伤的风险增加。是这样的 限制会直接影响身心健康，降低社会功能，减少劳动参与度。众所周知，VI是老年人经常面临的最致残的慢性疾病之一。除了其他慢性致残情况外，当人们必须与VI一起生活时，对发病率和死亡率可能产生的协同影响，以及这些影响如何以不同方式影响到少数群体等重要的利益群体，人们知之甚少。为了更好地了解患有和不患有其他慢性疾病的视障人士之间的健康差距如何与社会劣势协同作用，这项研究将利用国家健康访谈调查(NHIS)和医疗支出小组调查(MEPS)的数据来确定同时患有各种并存疾病的视障亚群，以及可能在发病率和死亡率方面不成比例(相对于普通人群)的视障亚群。一旦确定，将使用现有的先进统计建模技术对死亡风险方面毒性最大的VI和合并症组合进行分类和排名。然后，这项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寿命年(QALY)的差异分析，QALY是一种将疾病的发病率和死亡率合并为一个单一度量的指标，表示一个人剩下的最佳健康年数(即健康调整后的预期寿命)。这项拟议的研究将加深人们对视力损害对健康和寿命的有害影响的理解，而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关于复杂疾病模式(VI加上共生情况)的新信息，这些信息随后可用于识别和干预极高风险人群。这些研究旨在支持国家眼科研究所(NEI)眼睛流行病学战略规划报告的主要目标，其中包括：(1)确定不断变化的人口中眼部疾病的负担及其视力结果；(2)开发新的方法支持眼科流行病学研究。14拟议的研究还支持CDC和NEI改善与视力有关的人口健康的倡议，包括确定与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.