Epidemiology of Visual Impairment: The 1986-2002 NHIS

描述(由申请人提供)：尽管视力损害(VI)作为一个公共卫生问题很重要，但关于这种情况对发病率和死亡率的影响的研究相对较少。拟议的调查小组以前是由国家眼科研究所资助的，以利用1986-1994年国家健康访谈调查(NHIS)的数据帮助解决这一知识差距。1997年，国家健康保险制度得到了广泛的改进和重新设计。国家卫生统计中心(NCHS)已向科学界发布了截至2002年的NHIS数据集，其中包括195,907名成年人的VI状态信息；NCHS最近发布了2003年的数据，又增加了约73,000名参与者。有关功能状态、吸烟状况等重要风险因素的信息以及获得护理的机会是重新设计的NHIS的附加功能。此外，NCHS还为前几个调查年度(1986-1996年)的参与者以及到2002年重新设计的NHIS(1997-2000年)制定了与国家死亡指数定期更新的死亡率联系；现在，研究人员可以通过NCHS研究数据中心获得这一新的联系。重新设计的NHIS以及先前NHIS的更新死亡率链接将使目前的调查团队能够扩大当前应用程序中提议的特定目标的数量，以包括结构方程建模分析，以及一个网站，作为感兴趣的调查人员的唯一资源提供NHIS眼部数据和研究结果。我们的研究目标包括：1)使用结构方程模型，通过对1986-1996年和1997-2000年NHIS参与者的发病率和功能状态的“间接”影响，确定VI与死亡风险有关的程度；2)在1986-1996年NHIS的成年参与者中估计2002年内有和没有VI报告的成年人和选定的眼病的总体和原因特定死亡率；3)在1997-2000年NHIS参与者中估计2002年内有和没有VI报告的成年人的短期总体死亡率和原因特定死亡率，并对以前的NHIS调查中没有的协变量如吸烟状况进行额外的控制；4)使用重新设计的NHIS调查(1997-2003年)中的数据估计所报告的VI在社会人口亚组中的患病率和严重性；5)使用1997-2003年NHIS的数据评估各亚组(例如，年龄组、性别、种族、民族)VI的7年趋势；6)评估NHIS参与者报告的健康和残疾状况；7)评估VI与获得包括眼科护理在内的医疗保健之间的联系；以及8)制作和维护一个针对有兴趣使用正在进行的NHIS中可获得的眼部数据的其他科学家的网站。

DESCRIPTION (provided by applicant): Despite the importance of visual impairment (VI) as a public health problem there has been relatively little research on the influence of this condition on morbidity and mortality. The proposed investigative team was previously funded by the National Eye Institute to help, address this knowledge gap using data from the National Health Interview Survey (NHIS) 1986-1994. The NHIS was extensively improved and redesigned in 1997. The National Center for Health Statistics (NCHS) has released to the scientific community NHIS datasets thru 2002 which include information of the VI status of 195,907 adults; 2003 data have recently been released by NCHS adding approximately another 73,000 participants. Information on functional status, important risk factors such as smoking status, and access to care are additional features of the redesigned NHIS. In addition, the NCHS has instituted regular mortality linkage updates with the National Death Index for participants of the previous survey years (1986-1996) as well as for the redesigned NHIS (1997-2000) thru 2002; this new linkage is now available to investigators through the NCHS Research Data Center. The redesigned NHIS along with the updated mortality linkage for the previous NHIS will enable the present investigative team to expand the number of specific aims proposed in the current application to include structural equation modeling analysis as well as a website to provide NHIS ocular data and findings as a unique resource for interested investigators. Our study aims include: 1) Using structural equation modeling, determine the extent to which VI is related to mortality risk thru its "indirect" effect on morbidity and functional status among participants of the 1986-1996 and 1997-2000 NHIS's; 2) Estimate among adult participants of the 1986-1996 NHIS the overall and cause-specific mortality rates thru 2002 for adults with and without reported VI and selected eye diseases; 3) Estimate among participants of the 1997-2000 NHIS the short-term overall and cause-specific mortality rates thru 2002 for adults with and without reported VI additionally controlling for covariates not available in previous NHIS surveys such as smoking status; 4) Estimate the prevalence and severity of reported VI in sociodemographic subgroups using data from the redesigned NHIS survey (1997-2003); 5) Evaluate 7-year trends in VI in sub-groups (e.g., age-groups, gender, race, ethnicity) using data from the 1997-2003 NHIS's; 6) Evaluate the reported health and disability status of NHIS participants with and without reported VI; 7) Evaluate the association between VI and access to health care, including ophthalmic care; and 8) Produce and maintain a website directed at other scientists interested in using the ocular data available in the ongoing NHIS.