Impairments in Hearing and Vision Impact on Mortality
Impairments in Hearing and Vision Impact on Mortality
Objective: to examine the relationships between impairments in hearing and vision and mortality from all-causes and cardiovascular disease (CVD) among older people.
Design: population-based cohort study.
Participants: the study population included 4,926 Icelandic individuals, aged ≥67 years, 43.4% male, who completed vision and hearing examinations between 2002 and 2006 in the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-RS) and were followed prospectively for mortality through 2009.
Methods: participants were classified as having 'moderate or greater' degree of impairment for vision only (VI), hearing only (HI), and both vision and hearing (dual sensory impairment, DSI). Cox proportional hazard regression, with age as the time scale, was used to calculate hazard ratios (HR) associated with impairment and mortality due to all-causes and specifically CVD after a median follow-up of 5.3 years.
Results: the prevalence of HI, VI and DSI were 25.4, 9.2 and 7.0%, respectively. After adjusting for age, significantly (P < 0.01) increased mortality from all causes, and CVD was observed for HI and DSI, especially among men. After further adjustment for established mortality risk factors, people with HI remained at higher risk for CVD mortality [HR: 1.70 (1.27–2.27)], whereas people with DSI remained at higher risk of all-cause mortality [HR: 1.43 (1.11–1.85)] and CVD mortality [HR: 1.78 (1.18–2.69)]. Mortality rates were significantly higher in men with HI and DSI and were elevated, although not significantly, among women with HI.
Conclusions: older men with HI or DSI had a greater risk of dying from any cause and particularly cardiovascular causes within a median 5-year follow-up. Women with hearing impairment had a non-significantly elevated risk. Vision impairment alone was not associated with increased mortality.
Both vision and hearing loss are common age-related conditions, associated with poor health outcomes, including functional disability, depression and cognitive decline. Numerous studies in diverse populations suggest sensory impairments (SI) are predictors of decreased survival, independent of other traditional mortality risk factors such as hypertension and diabetes. However, data from the UK and Australia indicate that the association between visual impairment and mortality reflects concomitant morbidities. Similarly, an association between hearing impairment (HI) and mortality in the Blue Mountains Hearing study became non-significant after adjustment for risk factors. Analyses linking data from the National Health Interview Survey with the National Death Index in the USA suggested that deaf participants experienced decreased survival, but this finding was attributed to their lower self-reported health status. The joint effects of SI on health outcomes, including mortality risk, have not been investigated fully, particularly when compared with a single impairment.
As the population ages, the prevalence of hearing and visual impairments is expected to increase. This paper examines the risk of mortality associated with these impairments in the AGES-RS.
Abstract and Introduction
Abstract
Objective: to examine the relationships between impairments in hearing and vision and mortality from all-causes and cardiovascular disease (CVD) among older people.
Design: population-based cohort study.
Participants: the study population included 4,926 Icelandic individuals, aged ≥67 years, 43.4% male, who completed vision and hearing examinations between 2002 and 2006 in the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-RS) and were followed prospectively for mortality through 2009.
Methods: participants were classified as having 'moderate or greater' degree of impairment for vision only (VI), hearing only (HI), and both vision and hearing (dual sensory impairment, DSI). Cox proportional hazard regression, with age as the time scale, was used to calculate hazard ratios (HR) associated with impairment and mortality due to all-causes and specifically CVD after a median follow-up of 5.3 years.
Results: the prevalence of HI, VI and DSI were 25.4, 9.2 and 7.0%, respectively. After adjusting for age, significantly (P < 0.01) increased mortality from all causes, and CVD was observed for HI and DSI, especially among men. After further adjustment for established mortality risk factors, people with HI remained at higher risk for CVD mortality [HR: 1.70 (1.27–2.27)], whereas people with DSI remained at higher risk of all-cause mortality [HR: 1.43 (1.11–1.85)] and CVD mortality [HR: 1.78 (1.18–2.69)]. Mortality rates were significantly higher in men with HI and DSI and were elevated, although not significantly, among women with HI.
Conclusions: older men with HI or DSI had a greater risk of dying from any cause and particularly cardiovascular causes within a median 5-year follow-up. Women with hearing impairment had a non-significantly elevated risk. Vision impairment alone was not associated with increased mortality.
Introduction
Both vision and hearing loss are common age-related conditions, associated with poor health outcomes, including functional disability, depression and cognitive decline. Numerous studies in diverse populations suggest sensory impairments (SI) are predictors of decreased survival, independent of other traditional mortality risk factors such as hypertension and diabetes. However, data from the UK and Australia indicate that the association between visual impairment and mortality reflects concomitant morbidities. Similarly, an association between hearing impairment (HI) and mortality in the Blue Mountains Hearing study became non-significant after adjustment for risk factors. Analyses linking data from the National Health Interview Survey with the National Death Index in the USA suggested that deaf participants experienced decreased survival, but this finding was attributed to their lower self-reported health status. The joint effects of SI on health outcomes, including mortality risk, have not been investigated fully, particularly when compared with a single impairment.
As the population ages, the prevalence of hearing and visual impairments is expected to increase. This paper examines the risk of mortality associated with these impairments in the AGES-RS.
