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Original Investigation |

Burden of Visual Impairment and Chronic Diseases

Sang Jun Park, MD, MSc1,2; Soyeon Ahn, PhD3; 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
3Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
JAMA Ophthalmol. 2016;134(7):778-784. doi:10.1001/jamaophthalmol.2016.1158.
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Importance  Visual impairment (VI) is an emerging public health concern, especially considering the aging population. However, unlike other major chronic diseases, VI is often overlooked by investigators assessing the burden of diseases.

Objectives  To provide a description of preference weights for VI and chronic diseases from a national survey and estimate the corresponding burden of these diseases.

Design, Setting, and Participants  A cross-sectional study was conducted using a multistage, probability-cluster survey, which can produce nationally representative estimates. Data on 29 639 participants 19 years or older from the 2008-2012 Korean National Health and Nutrition Examination Survey were analyzed in terms of vision assessment, status of chronic diseases, and the European Quality of Life–Five Dimensions Questionnaire (EQ-5D). Visual impairment was defined as the presenting distance best-corrected visual acuity of worse than decimal 0.5. Data analysis was conducted from August 14, 2008, and September 7, 2015.

Main Outcomes and Measures  Preference weights (utilities) and prevalence-based quality-adjusted life-year (QALY) losses.

Results  Of the 29 639 participants, 28 382 with VA or EQ-5D measurements were included in the analysis; they had a mean (SE) age of 45.05 (0.19) years and a mean EQ-5D index of 0.948 (0.001). The preference weight for VI was −0.0549 (95% CI, −0.0777 to −0.0321), which was the third highest value among the 12 diseases analyzed—preceded only by the preference weights for osteoarthritis or rheumatoid arthritis (−0.0688; 95% CI, −0.748 to −0.0628) and stroke (−0.0666; 95% CI, −0.0854 to −0.0479). The estimated annual QALY loss from VI was −74.93 years per 100 000 person-years; this loss is comparable to or higher than that associated with other major chronic conditions (eg, diabetes mellitus, dyslipidemia, stroke, myocardial infarction/ischemic heart disease, asthma, obesity, and anemia). Visual impairment accounted for 4.77% of the total estimated QALY loss in the Korean population aged 19 years or older.

Conclusions and Relevance  The present study provides a description of preference weights for VI and various chronic diseases from a national survey. Furthermore, it reveals the distributions of public burden from these conditions, and compared them in this regard. Although details might vary across the populations having different cultural and socioeconomic backgrounds, the results underscore the importance of VI for quality of life and as a public health burden compared with other major chronic diseases.

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Figure 1.
Flowchart Showing the Numbers of Participants Included in the Analyses

EQ-5D indicates European Quality of Life–Five Dimensions Questionnaire; KNHANES, Korean National Health and Nutrition Examination Survey; and VI, visual impairment.

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Figure 2.
Quality-Adjusted Life-year (QALY) Losses and Estimated Preference Weights in the Representative Korean Population With Best-Corrected Visual Acuity (BCVA) Worse Than 0.5

A, Prevalence-based QALY. B, Utility of visual impairment (US definition: a distance BCVA of worse than 0.5 in the better-seeing eye). DL indicates dyslipidemia; DM, diabetes mellitus; HTN, hypertension; MI/IHD, myocardial infarction or ischemic heart disease; OA/RA, osteoarthritis or rheumatoid arthritis; RF, renal failure; Tb, pulmonary tuberculosis; and VI, visual impairment.

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Figure 3.
Quality-Adjusted Life-year (QALY) Losses and Estimated Preference Weights in the Representative Korean Population With Best-Corrected Visual Acuity (BCVA) Worse Than 0.32

A, Prevalence-based QALY. B, Utility of visual impairment (World Health Organization definition: a distance BCVA of worse than 0.32 in the better-seeing eye). DL indicates dyslipidemia; DM, diabetes mellitus; HTN, hypertension; MI/IHD, myocardial infarction or ischemic heart disease; OA/RA, osteoarthritis or rheumatoid arthritis; RF, renal failure; Tb, pulmonary tuberculosis; and VI, visual impairment.

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