Incidence, individual, and macro level risk factors of severe binocular visual impairment and blindness in persons aged 50 and older.

Daniel Kreft,Rudolf F Guthoff,Stefanie Frech,Gabriele Doblhammer

doi:10.1371/journal.pone.0251018

Daniel Kreft, Rudolf F Guthoff + Show 2 more

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https://doi.org/10.1371/journal.pone.0251018

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Abstract

ObjectiveThis study aims to estimate the incidence of severe binocular vision impairment and blindness (SVI/B) and to identify eye diseases and regional risk factors of persons with SVI/B at ages 50 years and older.MethodsWe designed an observational cohort study based on longitudinal, multifactorial, and administrative information of a random sample of 250,000 persons at ages 50+. All individuals were included in the process-produced health claims register of the Allgemeine Ortskrankenkasse in 2004, and were followed until 2015. We analyzed ten selected eye diseases and regional characteristics as risk factors for SVI/B using Cox models, adjusting for demographic characteristics and multi-morbidity.ResultsThe age-standardized incidence was 79 new diagnoses of SVI/B per 100,000 person-years (95%-CI: 76-82); 77 for males (72-82) and 81 for females (77-85). By adjusting for multiple factors, the model revealed and confirmed that individuals who were very old (Hazard ratio90+: 6.67; 3.59-12.71), male (1.18; 1.01-1.38), had multi-morbidities (three+ diseases: 3.36; 2.51-4.49), or had diabetes (1.26; 1.07-1.49) had an increased risk of SVI/B. Compared to persons without the particular eye disease (all p<0.001), persons diagnosed with secondary glaucoma had a multiple-adjusted 4.66 times (3.17-6.85) higher risk, those with retinal vascular occlusion had a 4.51 times (3.27-6.23) higher risk, and those with angle-closure glaucoma had a 4.22 times (2.60-6.85) higher risk. Population density was not a risk factor, while persons living in wealthier regions had 0.75 times (p=0.003) to 0.70 times (p<0.001) the risk of SVI/B than persons in the least wealthy regions of Germany.ConclusionThe study revealed and confirmed some profound risk factors of SVI/B at both the individual and the macro level. The sizes of the effects of the characteristics of the living context were smaller than those of the individual characteristics, especially for some severe eye diseases. While urbanity and access to health services had no effect, regional economic wealth was a risk factor for SVI/B. Future health care measures and advice by physicians should take these dimensions of inequalities in SVI/B into account.

Highlights

The loss of vision leads to severe limitations in quality of life and in independent living
Future health care measures and advice by physicians should take these dimensions of inequalities in severe binocular vision impairment and blindness (SVI/B) into account
A common characteristic of these eye diseases is that they worsen with age; due to population growth and aging, the number of people affected by vision impairment and blindness is increasing [1]

Summary

Introduction

The loss of vision leads to severe limitations in quality of life and in independent living. In 2015, 36.0 million people were estimated to be blind, and 216.6 million were reported to have moderate to severe vision impairment [1]. A common characteristic of these eye diseases is that they worsen with age; due to population growth and aging, the number of people affected by vision impairment and blindness is increasing [1]. In Europe, the estimated number of blind people aged 50 and older is 1.28 million, while another 9.99 million people have moderate or severe vision impairment. For Germany, the number of blind people has been estimated at 176,190 for 2017, with 43.67% of this population being aged 50 and older [3]

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