Visual acuity impairment and mortality in US adults

Objective: To examine the associations between reported visual impairment (VI) and mortality in a nationally representative sample of US adults. Methods: The National Health Interview Survey is a multistage probability survey of the US civilian population. Adults within households were administered questions about VI and selected eye diseases (n = 116 796). Mortality linkage data with more than 96% of the 1986-1994 survey participants were available through December 31, 1997. Statistical analyses included Cox proportional hazards regression analysis. Main Outcome Measures: All-cause, cardiovascular disease-related, and cancer-related mortality. Results: A total of 327 participants (0.3%) had severe bilateral VI; an additional 4754 (4%) had some VI and/or severe VI in at least one eye. Mortality linkage identified 8949 deaths. After controlling for survey design, age, race, marital status, educational level, reported health status, glaucoma, cataract, and retinopathy, women, but not men, with reported severe bilateral VI were at a significantly increased risk of death relative to their counterparts without VI (hazard ratio [95% confidence interval], 2.21 [1.61-3.02] and 1.33 [0.96-1.84], respectively); risk of mortality was also slightly but significantly elevated in women and men with some reported VI compared with those reporting no VI. Similar patterns of associations were found for cardiovascular disease-related mortality. Risk of cancer-related mortality was not associated with VI. Conclusion: Reported severe bilateral VI and, to a smaller extent, less severe VI are associated with an increased risk of all-cause mortality and cardiovascular disease-related mortality in US women; there is weaker evidence for an association between VI and mortality in US men.