American journal of ophthalmology · 2026
Visual Impairment as a Marker of Systemic Vulnerability and Cause-Specific Mortality in U.S. Adults.
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Kim Taemin, Liu Jonathan Z, Zhou Jane, Yang Andrew J, Sheen Michael, Parvaresh-Rizi Arianne, Chaaya Celine, Weng Chien-Hsiang, Patel Nimesh A
Аннотация
OBJECTIVE: To determine whether the excess mortality associated with visual impairment (VI) in U.S. adults is driven primarily by non-cardiovascular, non-cancer causes of death rather than cardiovascular or malignant causes.
DESIGN: Population-based cohort study.
SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Adults aged 40 years or older participating in the National Health and Nutrition Examination Survey (NHANES) 2001-2008 with measured presenting visual acuity in both eyes and eligibility for linkage to the National Death Index.
METHODS, INTERVENTION, OR TESTING: Presenting visual impairment was defined as visual acuity worse than 20/40 in the better-seeing eye using standardized examination protocols. Mortality outcomes were ascertained through December 31, 2019. Survey-weighted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, socioeconomic, and clinical covariates.
MAIN OUTCOME MEASURES: All-cause mortality. Secondary outcomes included non-cardiovascular, non-cancer mortality, cardiovascular mortality, and cancer mortality.
RESULTS: The analytic cohort included 11,938 participants, of whom 1179 (9.9%) had visual impairment at baseline. Over a mean follow-up of 13.2 years, visual impairment was most strongly associated with non-cardiovascular, non-cancer mortality (adjusted HR, 1.55; 95% CI, 1.30-1.84). Visual impairment was also associated with increased all-cause mortality (HR, 1.36; 95% CI, 1.17-1.57) and cardiovascular mortality (HR, 1.33; 95% CI, 1.02-1.72), but not cancer mortality (HR, 0.98; 95% CI, 0.69-1.40). Associations were robust across sensitivity analyses, including exclusion of participants with diabetes, exclusion of early deaths, and alternative visual impairment thresholds.
CONCLUSIONS: In this nationally representative cohort, visual impairment was independently associated with increased mortality, driven primarily by non-cardiovascular, non-cancer causes of death. These findings suggest that vision loss may serve as a marker of systemic vulnerability and support integrating vision assessment into chronic disease management and preventive care strategies.
DESIGN: Population-based cohort study.
SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Adults aged 40 years or older participating in the National Health and Nutrition Examination Survey (NHANES) 2001-2008 with measured presenting visual acuity in both eyes and eligibility for linkage to the National Death Index.
METHODS, INTERVENTION, OR TESTING: Presenting visual impairment was defined as visual acuity worse than 20/40 in the better-seeing eye using standardized examination protocols. Mortality outcomes were ascertained through December 31, 2019. Survey-weighted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, socioeconomic, and clinical covariates.
MAIN OUTCOME MEASURES: All-cause mortality. Secondary outcomes included non-cardiovascular, non-cancer mortality, cardiovascular mortality, and cancer mortality.
RESULTS: The analytic cohort included 11,938 participants, of whom 1179 (9.9%) had visual impairment at baseline. Over a mean follow-up of 13.2 years, visual impairment was most strongly associated with non-cardiovascular, non-cancer mortality (adjusted HR, 1.55; 95% CI, 1.30-1.84). Visual impairment was also associated with increased all-cause mortality (HR, 1.36; 95% CI, 1.17-1.57) and cardiovascular mortality (HR, 1.33; 95% CI, 1.02-1.72), but not cancer mortality (HR, 0.98; 95% CI, 0.69-1.40). Associations were robust across sensitivity analyses, including exclusion of participants with diabetes, exclusion of early deaths, and alternative visual impairment thresholds.
CONCLUSIONS: In this nationally representative cohort, visual impairment was independently associated with increased mortality, driven primarily by non-cardiovascular, non-cancer causes of death. These findings suggest that vision loss may serve as a marker of systemic vulnerability and support integrating vision assessment into chronic disease management and preventive care strategies.