Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 May 14;53(6):2685-92.
doi: 10.1167/iovs.11-8794.

Increased mortality risk among the visually impaired: the roles of mental well-being and preventive care practices

D Diane Zheng  1 , Sharon L Christ, Byron L Lam, Kristopher L Arheart, Anat Galor, David J Lee
Affiliations

Increased mortality risk among the visually impaired: the roles of mental well-being and preventive care practices

D Diane Zheng et al. Invest Ophthalmol Vis Sci. .

Abstract

Purpose: Mechanisms by which visual impairment (VI) increases mortality risk are poorly understood. We estimated the direct and indirect effects of self-rated VI on risk of mortality through mental well-being and preventive care practice mechanisms.

Methods: Using complete data from 12,987 adult participants of the 2000 Medical Expenditure Panel Survey with mortality linkage through 2006, we undertook structural equation modeling using two latent variables representing mental well-being and poor preventive care to examine multiple effect pathways of self-rated VI on all-cause mortality. Generalized linear structural equation modeling was used to simultaneously estimate pathways including the latent variables and Cox regression model, with adjustment for controls and the complex sample survey design.

Results: VI increased the risk of mortality directly after adjusting for mental well-being and other covariates (hazard ratio [HR] = 1.25 [95% confidence interval: 1.01, 1.55]). Poor preventive care practices were unrelated to VI and to mortality. Mental well-being decreased mortality risk (HR = 0.68 [0.64, 0.74], P < 0.001). VI adversely affected mental well-being (β = -0.54 [-0.65, -0.43]; P < 0.001). VI also increased mortality risk indirectly through mental well-being (HR = 1.23 [1.16, 1.30]). The total effect of VI on mortality including its influence through mental well-being was HR 1.53 [1.24, 1.90]. Similar but slightly stronger patterns of association were found when examining cardiovascular disease-related mortality, but not cancer-related mortality.

Conclusions: VI increases the risk of mortality directly and indirectly through its adverse impact on mental well-being. Prevention of disabling ocular conditions remains a public health priority along with more aggressive diagnosis and treatment of depression and other mental health conditions in those living with VI.

PubMed Disclaimer

Conflict of interest statement

Disclosure: D.D. Zheng, None; S.L. Christ, None; B.L. Lam, None; K.L. Arheart, None; A. Galor, None; D.J. Lee, None

Figures

Figure 1.
Figure 1.
Initial path diagram of visual impairment and mortality structural equation model.
Figure 2.
Figure 2.
Final path diagram of visual impairment and mortality structural equation model.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Wang JJ, Mitchell P, Simpson JM, Cumming RG, Smith W. Visual impairment, age-related cataract, and mortality. Arch Ophthalmol. 2001;119:1186–1190 - PubMed
    1. Thompson JR, Gibson JM, Jagger C. The association between visual impairment and mortality in elderly people. Age Ageing. 1989;18:83–88 - PubMed
    1. McCarty CA, Nanjan MB, Taylor HR. Vision impairment predicts 5 year mortality. Br J Ophthalmol. 2001;85:322–326 - PMC - PubMed
    1. Egge K, Zahl PH. Survival of glaucoma patients. Acta Ophthalmol Scand. 1999;77:397–401 - PubMed
    1. Podgor MJ, Cassel GH, Kannel WB. Lens changes and survival in a population-based study. N Engl J Med. 1985;313:1438–1444 - PubMed

Publication types