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

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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.

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