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Original Investigation |

Visual Function, Social Position, and Health and Life Chances The UK Biobank Study

Phillippa M. Cumberland, MSc1,2; Jugnoo S. Rahi, PhD, FRCOphth1,2,3,4,5 ; for the UK Biobank Eye and Vision Consortium
[+] Author Affiliations
1Life Course Epidemiology and Biostatistics Section, University College London Institute of Child Health, London, England
2Ulverscroft Vision Research Group, London, England
3Great Ormond Street Hospital, University College London Institute of Child Health Biomedical Research Centre, London, England
4Moorfields Eye Hospital National Health Service Foundation Trust, National Institute for Health Research, Moorfields Biomedical Research Centre, London, England
5University College London Institute of Ophthalmology, London, England
JAMA Ophthalmol. 2016;134(9):959-966. doi:10.1001/jamaophthalmol.2016.1778.
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Importance  The adverse impact of visual impairment and blindness and correlations with socioeconomic position are known. Understanding of the effect of the substantially more common near-normal vision (mild impairment) and associations with social position as well as health and life chances is limited.

Objective  To investigate the association of visual health (across the full acuity spectrum) with social determinants of general health and the association between visual health and health and social outcomes.

Design, Setting, and Participants  A cross-sectional epidemiologic study was conducted using UK Biobank data from 6 regional centers in England and Wales. A total of 112 314 volunteers (aged 40-73 years) were assessed in June 2009 and July 2010. Data analysis was performed from May 20, 2013, to November 19, 2014.

Main Outcomes and Measures  Habitual (correction if prescribed) distance visual acuity was used to assign participants to 1 of 8 categories from bilateral normal visual acuity (logMAR, 0.2 or better; Snellen equivalent, 6/9.5 or better) to visual impairment or blindness (logMAR, 0.5 or worse; Snellen equivalent, 6/19 or worse) using World Health Organization and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision taxonomy. Relationships between vision, key social determinants and health and social outcomes (including the main factors that define an individual’s life—the social, economic, educational, and employment opportunities and outcomes experienced by individuals during their life course) were examined using multivariable regression.

Results  Of the of 112 314 participants, 61 169 were female (54.5%); mean (SD) age was 56.8 (8.1) years. A total of 759 (0.7%) of the participants had visual impairment or blindness, and an additional 25 678 (22.9%) had reduced vision in 1 or both eyes. Key markers of social position were independently associated with vision in a gradient across acuity categories; in a gradient of increasing severity, all-cause impaired visual function was associated with adverse social outcomes and impaired general and mental health. These factors, including having no educational qualifications (risk ratio [RR], 1.86 [95% CI, 1.69-2.04]), having a higher deprivation score (RR, 1.08 [95% CI, 1.07-1.09]), and being in a minority ethnic group (eg, Asian) (RR, 2.05 [95% CI, 1.83-2.30]), were independently associated with being in the midrange vision category (at legal threshold for driving). This level of vision was associated with an increased risk of being unemployed (RR, 1.55 [95% CI, 1.31-1.84]), having a lower-status job (RR, 1.24 [95% CI, 1.09-1.41]), living alone (RR, 1.24 [95% CI, 1.10-1.39]), and having mental health problems (RR, 1.12 [95% CI, 1.04-1.20]).

Conclusions and Relevance  Impaired vision in adults is common, and even near-normal vision, potentially unrecognized without assessment, has a tangible influence on quality of life. Because inequalities in visual health by social position mirror other health domains, inclusion of vision in generic initiatives addressing health inequalities could address the existing significant burden of underrecognized and/or latent visual disability. Longitudinal investigations are needed to elucidate pathophysiologic pathways and target modifiable mechanisms.

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