Abstract
Objective: To assess the joint impact of cognitive performance and visual acuity on mortality over 13-year follow-up in a representative US sample.Methods: Data from National Health and Nutrition Examination Survey (NHANES) participants (≥18 years old) were linked with the death record data of the National Death Index (NDI) with mortality follow-up through December 31, 2011. Cognitive performance was evaluated by the Digit Symbol Substitution Test (DSST) and cognitive performance impairment was defined as the DSST score equal to or less than the median value in the study population. Visual impairment (VI) was defined as presenting visual acuity worse than 20/40 in the better-seeing eye. Risks of all-cause and specific-cause mortality were estimated with Cox proportional hazards models after adjusting for confounders.Results: A total of 2,550 participants 60 years and older from two waves of (NHANES, 1999–2000, 2001–2002) were included in the current analysis. Over a median follow-up period of 9.92 years, 952 (35.2%) died of all causes, of whom 239 (23.1%), 224 (24.0%), and 489 (52.9%) died from cardiovascular disease (CVD), cancer, and non-CVD/non-cancer mortality, respectively. Cognitive performance impairment and VI increased the odds for mortality. Co-presence of VI among cognitive impaired elderly persons predicted nearly a threefold increased risk of all-cause mortality [hazard ratios (HRs), 2.74; 95% confidence interval (CI), 2.02–3.70; P < 0.001) and almost a fourfold higher risk of non-CVD/non-cancer mortality (HR, 3.72; 95% CI, 2.30–6.00; P < 0.001) compared to having neither impairment.Conclusion: People aged 60 years and over with poorer cognitive performance were at higher risk of long-term mortality, and were especially vulnerable to further mortality when concomitant with VI. It is informative for clinical implication in terms of early preventive interventions.
Highlights
Life expectancy in industrialized countries has been projected to increase continuously, with most of the projected gains occurring in older ages (Kontis et al, 2017)
We evaluated the joint effect of cognitive performance impairment and visual impairment (VI) on mortality by adjusting for multiple covariates
A total of 3,234 participants aged 60 years or older participated in National Health and Nutrition Examination Survey (NHANES) (1999/2002)
Summary
Life expectancy in industrialized countries has been projected to increase continuously, with most of the projected gains occurring in older ages (Kontis et al, 2017). A non-negligible disadvantage to gains in longevity is the increased risk of the impairment of both vision and cognition with age. VI is highly prevalent among aged people, leading to morbidity, but imposing an impact on the risk of mortality as well (Zhang et al, 2016; Zhu et al, 2016). The extended life expectancy and aging population, rising rapidly around the world, have led to increasing prevalence of dementia (Brookmeyer et al, 2007). Cognitive decline and impairment associated with age have been proposed to be linked with an increased mortality (Sachs et al, 2011). Well-established identification and management on both visual and cognitive impairment are crucial for improving health in later lives
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