Association of Ocular Disease and Mortality in a Diabetic Population

Arch Ophthalmol. 1999 Nov;117(11):1487-95. doi: 10.1001/archopht.117.11.1487.

Abstract

Objective: To investigate the association of ocular disease with all-cause and cause-specific mortality in a diabetic population.

Design: Geographically defined population-based cohort study.

Setting: An 11-county area in Wisconsin.

Study population: Participants were all younger-onset diabetic persons (diagnosed as having diabetes at <30 years of age and taking insulin) and a random sample of older-onset diabetic persons (diagnosed as having diabetes at > or =30 years of age). Diabetic retinopathy, macular edema, visual acuity, and cataract were measured using standardized protocols at baseline examinations from 1980 to 1982, in which 996 younger-onset and 1370 older-onset persons participated. Participants were followed up for 16 years.

Main outcome measure: All-cause and cause-specific mortality as determined from death certificates.

Results: In the younger-onset group, after controlling for age and sex, retinopathy severity, macular edema, cataract, history of cataract surgery, and history of glaucoma at baseline were associated with all-cause and ischemic heart disease mortality. In the older-onset group, after controlling for age and sex, retinopathy and visual impairment were related to all-cause, ischemic heart disease, and stroke mortality. No ocular variable under study was related to cancer mortality in the older-onset group. After controlling for systemic risk factors, visual impairment was associated with all-cause and ischemic heart disease mortality in the younger-onset group. In the older-onset group, retinopathy severity was related to all-cause and stroke mortality, and visual impairment was related to all-cause, ischemic heart disease, and stroke mortality.

Conclusions: Presence of more severe retinopathy or visual impairment in diabetic patients is a risk indicator for increased risk of ischemic heart disease death. Presence of these ocular conditions may identify individuals who should be under care for cardiovascular disease.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cataract / complications
  • Cause of Death
  • Diabetes Mellitus / mortality*
  • Diabetic Retinopathy / complications
  • Eye Diseases / complications*
  • Female
  • Glaucoma / complications
  • Humans
  • Macular Edema / complications
  • Male
  • Middle Aged
  • Myocardial Ischemia / mortality*
  • Risk Factors
  • Stroke / mortality*
  • Vision Disorders / complications
  • Wisconsin / epidemiology