非屈光性视力损伤及其严重程度是导致全因死亡率和糖尿病特异性死亡率的独立风险因素

Association of nonrefractive visual impairment with risk of all-cause and specific-cause mortality in the National Health and Nutrition Examination Survey, 1999 to 2008

1999 年至 2008 年全国健康与营养调查中，非屈光性视力损伤与全因和特定原因死亡风险的关系

Authors: Siyu Gui, Xinchen Wang, Qianqian Wang, Lan Zhong, Jianchao Qiao, Yueyang Xu, Yiran Li, Zhihao Huang, Chengyang Hu, Fangbiao Tao, Xiaodong Sun, Heting Liu, Jie Gao

Source: BMC Public Health

DOI: 10.1186/s12889-025-22249-7

Abstract

OBJECTIVE: To investigate and describe the impact of nonrefractive visual impairment (NVI) and its severity on all-cause and cause-specific mortality, along with the latest estimations.

METHODS: Cox proportional hazards regression models with multiple covariate adjustments and Fine-Gray competing risk regression models assessed the risk of all-cause and specific-cause mortality. Propensity score matching (PSM) was employed to achieve covariate balance.

RESULTS: Among 7,961 participants (representing 171 383 125 non-institutionalized US individuals), baseline NVI was present in 350 participants (4.40%), with 313 (3.93%) having mild NVI and 37 (0.47%) having severe NVI. Both any NVI and Severe NVI were associated with increased all-cause and diabetes mellitus (DM)-related mortality. After PSM, the results remained consistent (for all-cause mortality: HR, 1.34; 95% CI, 1.05-1.70; for DM-related mortality: HR, 3.54; 95% CI, 1.15-10.97). Severity analysis demonstrated a significant trend between increasing NVI severity and elevated risks of all-cause and DM-specific mortality.

CONCLUSION: Our findings confirm that NVI and its severity are independent risk factors for all-cause and DM-specific mortality among the US population. This highlights the importance of regular visual acuity examinations, particularly for NVI screening, especially in individuals with diabetes.

Keywords: Visual impairment, All-Cause mortality, Specific-Cause mortality

摘要

目的：调查并描述非屈光性视力损伤（NVI）及其严重程度对全因死亡率和特定原因死亡率的影响，以及最新的估算结果。

方法：经多重协变量调整的 Cox 比例危险回归模型和 Fine-Gray 竞争风险回归模型评估了全因和特定原因死亡率的风险。采用倾向评分匹配（PSM）来实现协变量平衡。

结果：在 7 961 名参与者（代表 171 383 125 名非住院美国人）中，350 名参与者（4.40%）存在基线 NVI，其中 313 人（3.93%）有轻度 NVI，37 人（0.47%）有重度 NVI。任何 NVI 和严重 NVI 都与全因死亡率和糖尿病相关死亡率的增加有关。PSM 后，结果保持一致（全因死亡率：HR，1.34；95% CI，1.05-1.70；糖尿病相关死亡率：HR，3.54；95% CI，1.15-10.97）。严重程度分析表明，NVI 严重程度的增加与全因死亡率和 DM 特异性死亡率风险的升高之间存在明显的趋势。

结论：我们的研究结果证实，在美国人群中，NVI 及其严重程度是导致全因死亡率和糖尿病特异性死亡率的独立风险因素。这凸显了定期视力检查的重要性，尤其是对糖尿病患者进行 NVI 筛查。

关键词： 全因死亡率；特定原因死亡率；视力损伤