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Original Investigation |

Extent of Exacerbation of Chronic Health Conditions by Visual Impairment in Terms of Health-Related Quality of Life

Sang Jun Park, MD, MSc1,2; Soyeon Ahn, PhD3; Se Joon Woo, MD, PhD1; Kyu Hyung Park, MD, PhD1
[+] Author Affiliations
1Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
2Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
3Medical Research Collaborating Center, Division of Statistics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
JAMA Ophthalmol. 2015;133(11):1267-1275. doi:10.1001/jamaophthalmol.2015.3055.
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Importance  Visual impairment (VI) causes a considerable public health burden and substantial deterioration in health-related quality of life (HRQoL). However, the relative effect of VI on HRQoL compared with other chronic health conditions is unknown as is the additive effect of VI with other conditions.

Objective  To investigate whether the impact of chronic health conditions on HRQoL varies according to VI presence.

Design, Setting, and Participants  Cross-sectional study involving 29 639 participants aged 19 years and older and using a multistage, probability-cluster survey, which can produce nationally representative estimates. We analyzed data from the 2008-2012 Korean National Health and Nutrition Examination Survey, which included results for vision assessment and HRQoL, measured using the European Quality of Life–5 Dimensions Questionnaire (EQ-5D). All analyses were conducted in October and November 2014. Visual impairment was defined as the presenting distance best-corrected visual acuity of less than decimal 0.32 (approximate Snellen equivalent 20/63). Linear regression models accounting for sample weights were used to examine interactions between VI and each of 14 chronic health conditions on the EQ-5D index score, adjusted for demographic and socioeconomic covariates.

Main Outcomes and Measures  The EQ-5D index score for participants with VI or 14 chronic health conditions, as well as the effect of the interactions between VI and each condition on the EQ-5D index score.

Results  The EQ-5D index score with VI was substantially lower than without VI (mean difference, −0.158; 95% CI, −0.186 to −0.130; P < .001). In most conditions, the comorbidity with VI resulted in lower EQ-5D index scores; furthermore, participants with stroke, osteoarthritis or rheumatic arthritis, hepatitis B or C, and depression showed lower EQ-5D index scores than expected when they were comorbid with VI, indicating an interaction between VI and each condition. The estimated β coefficients for interaction terms were −0.256 (95% CI, −0.480 to −0.032) for stroke, −0.124 (95% CI, −0.223 to −0.026) for osteoarthritis or rheumatic arthritis, −0.183 (95% CI, −0.327 to −0.038) for hepatitis B or C, and −0.130 (95% CI, −0.229 to −0.032) for depression.

Conclusions and Relevance  These results suggest that VI has a substantial effect on HRQoL, even in the presence of concurrent chronic health conditions, and the combined effect of VI and stroke, osteoarthritis/rheumatic arthritis, hepatitis, or depression on HRQoL was greater. However, because this study group was a representative sampling of South Koreans, generalization to other races/ethnicities and countries should be approached with caution.

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Figure.
Model-Based Predictive Means (95% CIs) of Visual Impairment (VI)–Stratified European Quality of Life–5 Dimensions Questionnaire (EQ-5D) Index Scores for Chronic Health Conditions

The model-based predictive mean for each chronic health condition is the linear prediction of EQ-5D index score using the average value of the covariates including age, smoking status, household income, education, occupation, and living situation. The estimated regression coefficient of interaction terms between VI and each chronic health condition and corresponding 95% CIs are provided in each graph. To evaluate the interaction between VI and each chronic health condition, the regression model includes VI, each chronic health condition, the interaction between VI and each chronic health condition, and the listed covariates. OA indicates osteoarthritis; RA, rheumatic arthritis.

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