Vision Impairment in the National Health and Aging Trends Study: Epidemiology, Social Determinants of Health, and Adverse Late Life Outcomes

国家健康和老龄化趋势研究中的视力障碍：流行病学、健康的社会决定因素和不良的晚年结局

• 批准号: 10730418
• 负责人: Joshua Robert Ehrlich
• 金额: $ 66.16万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10730418
• 关键词: Address; Admission activity; Adopted; Adult; Affect; Aged, 80 and over; Aging; Black Populations; Blindness; Collaborations; Complement; Complex; Contrast Sensitivity; Data; Dementia; Development; Diagnosis; Economics; Elderly; Epidemiology; Ethnic Origin; Ethnic Population; Eye; Eye diseases; Funding; Growth; Health; Health care facility; Healthcare Systems; Hispanic Populations; Impairment; Incidence; Individual; Link; Long-Term Care; Measurement; Measures; Mediating; Mediation; Medicare; Medicare claim; Mission; Modeling; National Eye Institute; Neighborhoods; Outcome; Personal Satisfaction; Persons; Policies; Population; Prevalence; Protocols documentation; Public Health; Public Policy; Race; Reporting; Research; Research Personnel; Research Support; Risk Factors; Sample Size; Sampling; Strategic Planning; Surveys; System; Testing; Time; United States National Institutes of Health; Validation; Vision; Vision Tests; Visual; Visual Acuity; Visual impairment; Work; adverse outcome; age group; age stratification; beneficiary; blind; built environment; comorbidity; contextual factors; data archive; demographics; disability; dissemination strategy; epidemiologic data; ethnic minority; experience; health care availability; health disparity; health equity; human old age (65+); insight; interest; longitudinal analysis; mortality; novel; population based; prospective; racial minority; racial minority population; sex; social health determinants; social media; socioeconomics; symposium; trend

PROJECT SUMMARY/ABSTRACT At least 14 million people in the U.S. are blind or living with a vision impairment (VI), and the number affected is projected to double by 2050 due to aging and growth of the U.S. population. The majority of those with VI and blindness are older adults aged ≥65 years. Racial and ethnic minorities are also disproportionately affected, in part due to social determinants of health (SDoH) like healthcare access, economic stability, and features of the built environment. Particularly in later life, VI is thought to be associated with a host of adverse outcomes, including dementia, admission to a long-term care facility, and even mortality. Nonetheless, rigorous and generalizable research on how SDoH impact vision and eye health, and how vision influences late-life outcomes has been limited due to a lack of data that: (i) is longitudinal; (ii) is representative of the U.S. population; (iii) contains objective assessments of visual function; and (iv) samples older adults. In the proposed project, we will address this barrier using newly collected vision data from the NIH-funded National Health and Aging Trends Study (NHATS), an ongoing nationally representative panel study of >7,000 adults aged ≥65 years. In 2021, NHATS began annual measurement of distance and near visual acuity and contrast sensitivity. In Aim 1 of the proposed study, we use NHATS data to provide the first-ever estimates on the incidence of VI and blindness at the national level, as well as national prevalence estimates stratified by age, sex, and race and ethnicity. In Aim 2, we will evaluate the longitudinal influence of SDoH on vision health. To do so, we will utilize individual-level indicators of SDoH from NHATS, and neighborhood level-indicators from the NIH-funded National Neighborhood Data Archive that is linked to NHATS. In Aim 3, we will investigate the longitudinal impact of VI and blindness on the development of dementia, placement in long-term care, and all-cause mortality. In a sub-aim, we will use a longitudinal mediation model to test whether the influence of SDoH on adverse late-life outcomes is mediated by vision and eye health. To date, it has not been possible to carry out nationally representative studies on the associations of VI with SDoH and key late-life outcomes due to the lack of longitudinal and objectively measured visual function data in a national sample. Thus, the proposed studies will address critical scientific gaps. This proposal is also highly responsive to the National Eye Institute’s new 5-year Strategic Plan, including: (i) to gather current epidemiologic data; (ii) to support research at the nexus of SDoH and the healthcare system; and (iii) to explore research encompassing comorbidities. Epidemiological estimates will be made publicly available and all study findings will be widely disseminated to maximize the impact of these studies on public health and policy and to optimize vision and overall health and wellbeing for an aging U.S. population.

项目概要/摘要 美国至少有 1400 万人失明或患有视力障碍 (VI)，并且该数字 由于美国人口老龄化和增长，预计到 2050 年，受影响的人数将增加一倍。 患有 VI 和失明的人中，年龄≥65 岁的老年人也是少数族裔。 受到不成比例的影响，部分原因是医疗保健等健康社会决定因素 (SDoH) 尤其是在以后的生活中，VI 被认为是可及性、经济稳定性和建筑环境的特征。 与一系列不良后果相关，包括痴呆症、接受长期护理 然而，关于 SDoH 如何影响的严格且普遍的研究 由于缺乏相关知识，视力和眼睛健康以及视力对晚年结果的影响受到限制。 数据：(i) 是纵向数据；(ii) 代表美国人口；(iii) 包含客观数据； 视觉功能评估；以及（iv）对老年人进行抽样。 使用 NIH 资助的国家健康与老龄化中心新收集的视力数据来解决这一障碍 趋势研究 (NHATS)，一项正在进行的全国代表性小组研究，对象为超过 7,000 名 ≥ 65 岁的成年人 2021 年，NHATS 开始每年测量远视力、近视力和对比度。 在拟议研究的目标 1 中，我们使用 NHATS 数据提供了有史以来的首次估计。 国家一级 VI 和失明的发生率以及国家患病率估计 按年龄、性别、种族和民族分层。在目标 2 中，我们将评估纵向影响。 为此，我们将利用 NHATS 的个人层面 SDoH 指标，以及 来自 NIH 资助的国家邻里数据档案馆的邻里级别指标已链接 在 NHATS 的目标 3 中，我们将研究 VI 和失明对 痴呆症的发展、长期护理的安置和全因死亡率。 使用纵向中介模型来检验 SDoH 是否对不良晚年产生影响 结果是由视力和眼睛健康调节的，迄今为止还不可能实现。 关于 VI 与 SDoH 以及关键晚年结局之间关系的全国代表性研究 全国样本中缺乏纵向和客观测量的视觉功能数据。 拟议的研究将解决关键的科学差距。 国家眼科研究所新的五年战略计划，包括：(i) 收集当前的流行病学数据； (ii) 支持 SDoH 与医疗保健系统之间关系的研究；以及 (iii) 探索研究； 流行病学估计将公开，所有研究 研究结果将广泛传播，以最大限度地发挥这些研究对公共卫生和 政策并优化美国老龄化人口的视力以及整体健康和福祉。