Study Explores Associations of Chronic Conditions with Visual Impairment

While it is common knowledge that ophthalmic disorders are often systemic in nature, new research from the Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine is shedding light on specific patterns of multimorbidity and how these patterns can be used to improve outcomes.

Data from a cross-sectional study that included more than information on more than 350k found 4 distinct groups of chronic conditions patterns, including the presence of conditions like hypertension and asthma, associated with an increased risk of visual impairment compared to healthy patients.

In an effort to evaluate chronic conditions patterns and their potential associations with visual impairment and health care use, investigators conducted a study using the National Health Interview Survey (NHIS) data from 2002-2014. A total of 13 chronic health conditions were selected for inclusion, including hypertension, coronary heart disease (CHD), stroke, any heart condition, emphysema or COPD, asthma, cancer, diabetes, arthritis, kidney disease, hepatitis, psychologic distress, and hearing impairment.

Both visual impairment and emergency department (ED) visits were assessed via NHIS questions. Investigators noted the questions evaluating ED visits pertained to visits within the last 12 months—they also assessed whether they had been in hospital overnight in the same period.

Of the 387,780 individuals identified for inclusion in the study, the mean age was 46.2 (18.0) years and 51.8% were female—investigators pointed out 77.6% were white, 11.8% were black, 4.6% were Asian, and 6% were defined as other race. Additionally, the most common comorbid conditions were hypertension (28.1%), arthritis (22.1%), and hearing impairment (15.8%).

As part of their latent class analysis, 5 different classes were identified—with 70.5% of the 387,780 were included in the healthy control group. The other 4 groups represented various degrees and patterns in multimorbidity; these groups were identified as the hypertensive group (19.6%), the respiratory conditions group (4.4%), the heart disease group (3.6%), and the severely impaired group (1.8%).

Investigators noted the hypertensive group had a high prevalence of hypertension (62.6%), the heart disease group had a high prevalence of CHD (69.8%), the respiratory conditions group had a high prevalence of emphysema (47.7%) and asthma (45.6%), while patients in the severely impaired group had a higher prevalence of most conditions compared with the other groups.

Results of the investigators’ analyses indicated that all chronic condition groups had an increased risk for reporting visual impairment. In comparison to the healthy group, individuals in the severely impaired group was the most likely to report visual impairment (OR 10.19; 95% CI, 9.20-11.28), followed by those in the respiratory condition group (OR 3.87; 95% CI, 3.56-4.20), then hypertensive group (OR 3.28; 95% CI, 3.10-3.48), and, lastly, the heart condition group (OR 3.19; 95% CI, 2.92-3.48).

Similar trends were found when examining health care use, as individuals from all 4 condition groups were more likely to report healthcare use compared to the healthy group. Compared to those in the healthy group, individuals in the severely impaired group were the most likely to report ED visits (OR 9.39; 95% CI, 8.53-10.34) and hospitalization (OR 10.80; 95% CI, 9.80-11.92), followed by the heart condition group (ED use: OR 4.17; 95% CI, 3.90-4.46; hospitalization: OR 7.44 95% CI, 6.89-8.03), the respiratory condition group (ED use: OR 3.67; 95% CI, 3.44-3.91; hospitalization: OR 3.08; 95% CI, 2.83- 3.36), and, lastly, the hypertensive group (ED use: OR, 2.39 95% CI, 2.29-2.49; hospitalization: OR 2.91; 95% CI, 2.74-3.08).

Investigators suggest the data from the current study could provide insight to clinicians and aid in enhancing care coordination. Investigators also point out results could help identify high-risk populations.

This study, “Patterns of Chronic Conditions and Their Association With Visual Impairment and Health Care Use,” was published in JAMA Ophthalmology.