Impairments in Hearing and Vision Impact on Mortality
Impairments in Hearing and Vision Impact on Mortality
Among 4,926 participants, sensory impairment was present in 2,048 (41.6%) participants, of whom 1,250 (25.4%) had HI only, 455 (9.2%) VI only and 343 (7.0%) DSI. Participant characteristics are shown by the impairment group in Table 1. The mean age of the VI, HI and DSI groups was significantly higher compared with the unimpaired group. Among those with a given impairment, women were more likely than men to have VI (10.5 versus 7.6%, P = 0.10), whereas men were significantly more likely than women to have HI or DSI (29.9 versus 22.0%, P < 0.01 and 8.6 versus 5.7%, P < 0.01, respectively). After adjusting for age and sex, the impaired groups had significantly less education, poorer self-reported health, more depressive symptomology, cognitive impairment, walking disability and higher rates of diabetes.
Between their baseline examination and the end of the follow-up period (median follow-up, 5.3 years, range 3–7 years), 846 (17.2%) individuals died, of which 360 (42.6%) were attributed to CVD. Participants who died were significantly older (79.6 ± 5.7 versus 75.2 ± 4.9 years, P < 0.01) and more likely to be male (51.3 versus 39.8%, P < 0.01), a current or former smoker, report poor health, be cognitively impaired, have diabetes, a history of cancer, angina, CVD or cardiovascular event, higher HDL cholesterol levels and lower total cholesterol levels.
All-cause and CVD-related mortality rates among men and women were significantly different overall (both P < 0.01) and within each sensory impairment group, particularly the DSI group (all-cause: no SI, P < 0.01; VI, P = 0.03; HI, P < 0.01; DSI, P < 0.01; interaction between sex and SI, P = 0.09 and CVD: no SI, P = 0.09; VI, P = 0.08; HI, P = 0.01; DSI, P < 0.01; interaction between sex and SI, P = 0.07). Men were more impaired and more severely impaired in vision and hearing compared with women (results not shown). Adjusting for age differences, Figure 1 depicts mortality by sex for all-causes and CVD over the 7-year follow-up period for the four impairment groups.
(Enlarge Image)
Figure 1.
Kaplan–Meier plots for all-cause and CVD-related mortality rates by type of sensory impairment, stratified by sex and adjusted for age.
Compared with the unimpaired group, after adjustment for sex and age, participants with HI were at higher risk of CVD-related mortality [HR: 1.52 (95% CI: 1.17–1.97)], whereas participants with DSI were at higher risk of death from any cause [HR: 1.50 (95% CI: 1.19–1.90)] or from CVD [HR: 1.80 (95% CI: 1.24–2.61)], as shown in Table 2. After adjusting for established mortality risk factors, including smoking, BMI, hypertension, diabetes, self-reported health status, cognitive status, self-reported history of falls, total cholesterol, baseline CVD history and hearing aid use, DSI remained associated with all-cause mortality [HR: 1.43 (95% CI: 1.11–1.85)] and HI and DSI remained associated with CVD mortality [HRs: 1.70 (95% CI: 1.27–2.27) and 1.78 (95% CI: 1.18–2.69), respectively].
Compared with unimpaired men, after multivariable adjustment, men with DSI had increased risk of all-cause and CVD-related mortality [HRs: 1.73 (95% CI: 1.25–2.39) and 2.65 (95% CI: 1.58–4.44), respectively], whereas HI was significantly associated with CVD-related mortality [HR: 1.93 (95% CI: 1.30–2.87)] but not with all-cause mortality [HR: 1.20 (95% CI: 0.93–1.55)]. In women, associations between HI and all-cause or CVD-related mortality did not reach statistical significance [HRs: 1.23 (95% CI: 0.93–1.64) and 1.44 (95% CI: 0.93–2.22), respectively], and no associations were found between DSI and all-cause or CVD-related mortality.
Among people with HI or DSI, users of hearing aids were, on average, older and had more severe hearing loss compared with people without hearing aids; however, hearing aid users had significantly lower risk of all-cause mortality [HRs: 0.75 (95% CI: 0.58–0.96) for men and 0.67 (95% CI: 0.49–0.92) for women] and, among men, CVD-related mortality risk [HR: 0.63 (95% CI: 0.42–0.92)].
Results
Among 4,926 participants, sensory impairment was present in 2,048 (41.6%) participants, of whom 1,250 (25.4%) had HI only, 455 (9.2%) VI only and 343 (7.0%) DSI. Participant characteristics are shown by the impairment group in Table 1. The mean age of the VI, HI and DSI groups was significantly higher compared with the unimpaired group. Among those with a given impairment, women were more likely than men to have VI (10.5 versus 7.6%, P = 0.10), whereas men were significantly more likely than women to have HI or DSI (29.9 versus 22.0%, P < 0.01 and 8.6 versus 5.7%, P < 0.01, respectively). After adjusting for age and sex, the impaired groups had significantly less education, poorer self-reported health, more depressive symptomology, cognitive impairment, walking disability and higher rates of diabetes.
Between their baseline examination and the end of the follow-up period (median follow-up, 5.3 years, range 3–7 years), 846 (17.2%) individuals died, of which 360 (42.6%) were attributed to CVD. Participants who died were significantly older (79.6 ± 5.7 versus 75.2 ± 4.9 years, P < 0.01) and more likely to be male (51.3 versus 39.8%, P < 0.01), a current or former smoker, report poor health, be cognitively impaired, have diabetes, a history of cancer, angina, CVD or cardiovascular event, higher HDL cholesterol levels and lower total cholesterol levels.
All-cause and CVD-related mortality rates among men and women were significantly different overall (both P < 0.01) and within each sensory impairment group, particularly the DSI group (all-cause: no SI, P < 0.01; VI, P = 0.03; HI, P < 0.01; DSI, P < 0.01; interaction between sex and SI, P = 0.09 and CVD: no SI, P = 0.09; VI, P = 0.08; HI, P = 0.01; DSI, P < 0.01; interaction between sex and SI, P = 0.07). Men were more impaired and more severely impaired in vision and hearing compared with women (results not shown). Adjusting for age differences, Figure 1 depicts mortality by sex for all-causes and CVD over the 7-year follow-up period for the four impairment groups.
(Enlarge Image)
Figure 1.
Kaplan–Meier plots for all-cause and CVD-related mortality rates by type of sensory impairment, stratified by sex and adjusted for age.
Compared with the unimpaired group, after adjustment for sex and age, participants with HI were at higher risk of CVD-related mortality [HR: 1.52 (95% CI: 1.17–1.97)], whereas participants with DSI were at higher risk of death from any cause [HR: 1.50 (95% CI: 1.19–1.90)] or from CVD [HR: 1.80 (95% CI: 1.24–2.61)], as shown in Table 2. After adjusting for established mortality risk factors, including smoking, BMI, hypertension, diabetes, self-reported health status, cognitive status, self-reported history of falls, total cholesterol, baseline CVD history and hearing aid use, DSI remained associated with all-cause mortality [HR: 1.43 (95% CI: 1.11–1.85)] and HI and DSI remained associated with CVD mortality [HRs: 1.70 (95% CI: 1.27–2.27) and 1.78 (95% CI: 1.18–2.69), respectively].
Compared with unimpaired men, after multivariable adjustment, men with DSI had increased risk of all-cause and CVD-related mortality [HRs: 1.73 (95% CI: 1.25–2.39) and 2.65 (95% CI: 1.58–4.44), respectively], whereas HI was significantly associated with CVD-related mortality [HR: 1.93 (95% CI: 1.30–2.87)] but not with all-cause mortality [HR: 1.20 (95% CI: 0.93–1.55)]. In women, associations between HI and all-cause or CVD-related mortality did not reach statistical significance [HRs: 1.23 (95% CI: 0.93–1.64) and 1.44 (95% CI: 0.93–2.22), respectively], and no associations were found between DSI and all-cause or CVD-related mortality.
Among people with HI or DSI, users of hearing aids were, on average, older and had more severe hearing loss compared with people without hearing aids; however, hearing aid users had significantly lower risk of all-cause mortality [HRs: 0.75 (95% CI: 0.58–0.96) for men and 0.67 (95% CI: 0.49–0.92) for women] and, among men, CVD-related mortality risk [HR: 0.63 (95% CI: 0.42–0.92)].
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