Visual Impairment in White, Chinese, Black, and Hispanic Participants from the Multi-Ethnic Study of Atherosclerosis Cohort

<div><p></p><p><i>Purpose</i>: To describe the prevalence of visual impairment and examine its association with demographic, socioeconomic, and health characteristics in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.</p><p><i>Methods</i>: Visual acuity data were obtained from 6134 participants, aged 46–87 years at time of examination between 2002 and 2004 (mean age 64 years, 47.6% male), from six communities in the United States. Visual impairment was defined as presenting visual acuity 20/50 or worse in the better-seeing eye. Risk factors were included in multivariable logistic regression models to determine their impact on visual impairment for men and women in each racial/ethnic group.</p><p><i>Results</i>: Among all participants, 6.6% (<i>n</i> = 421) had visual impairment, including 5.6% of men (<i>n</i> = 178) and 7.5% of women (<i>n</i> = 243). Prevalence of impairment ranged from 4.2% (<i>n</i> = 52) and 6.0% (<i>n</i> = 77) in white men and women, respectively, to 7.6% (<i>n</i> = 37) and 11.6% (<i>n</i> = 44) in Chinese men and women, respectively. Older age was significantly associated with visual impairment in both men and women, particularly in those with lower socioeconomic status, but the effects of increasing age were more pronounced in men. Two-thirds of participants already wore distance correction, and not unexpectedly, a lower prevalence of visual impairment was seen in this group; however, 2.4% of men and 3.5% of women with current distance correction had correctable visual impairment, most notably among seniors.</p><p><i>Conclusion</i>: Even in the U.S. where prevalence of refractive correction is high, both visual impairment and uncorrected refractive error represent current public health challenges.</p></div

Ten-year CAC progression by baseline AMD status (No AMD vs. Any AMD).

<p>Ten-year CAC progression by baseline AMD status (No AMD vs. Any AMD).</p

Flow diagram describing the studied cohort.

<p>Flow diagram describing the studied cohort.</p

Hazard ratios for hip fractures according to serum 25-hydroxyvitamin D categories among all subjects (N = 5461), and stratified by sex.

<p>Abbreviations: HR Hazard Ratio, CI confidence interval.</p>1<p>Chi-square test (type 3).</p>2<p>Adjusted for age at recruitment, sex (when all subjects are included), height, body mass index, current smoking, season of blood sampling and alcohol intake.</p>3<p>Additionally adjusted for current physical activity.</p

Hip fracture incidence (%) during a follow-up of 5.4 years (SD1.5) among AGES participants (N = 5461) according to serum baseline categories of 25(OH)D.

<p>Unadjusted values.</p

Differences in z-score (number of SD from age corrected mean) of femoral neck bone mineral density according to serum 25-hydroxyvitamin D categories at baseline (N = 4782).

<p>Abbreviations: CI confidence interval.</p>1<p>F-test (type 3).</p>2<p>Adjusted for age at recruitment, sex (when all subjects are included), height, body mass index, current smoking, season of blood sampling and alcohol intake.</p>3<p>Additionally adjusted for current physical activity.</p

Digital photograph a MESA participant's retina showing central retinal vascular caliber.

<p>The caliber of retinal vessels is a calculated average of measurements of all arterioles and venules coursing through an area one half to one full disc diameter from the optic disc margin. Red shaded areas are used to compute the central retinal artery equivalent (CRAE) and blue shaded areas are used to compute the central retinal vein equivalent (CRVE).</p

Mean differences in lung function and percent low attenuation area (%LAA) by myocardial blood flow (MBF) at rest and during hyperemia.

<p>Abbreviations: SD = standard deviation; MBF = myocardial blood flow; CI = confidence interval;</p>†<p>Model 1: Adjusted for age, gender, race/ethnicity, body mass index, height, waist and hip circumference and, for CT analyses, CT scanner type.</p>‡<p>Model 2: Adjusted for all the variables in model 1 plus cigarette smoking status, cigarette pack years and urine cotinine.</p>§<p>Model 3: Adjusted for all the variables in model 2 plus cigar-years, pipe-years, environmental tobacco exposure, occupational exposure to dust, asthma before age 45, family history of emphysema, chronic bronchitis, educational attainment, diabetes mellitus, fasting blood glucose, hypertension, systolic blood pressure, diastolic blood pressure, heart rate, high-density lipoprotein, low-density lipoprotein, C reactive protein, fibrinogen, aspirin use, beta blocker use, angiotensin II receptor blocker and/or angiotensin converting enzyme inhibitor use, statin use, diuretic use, hormone replacement therapy use, bronchodilator use, oral or inhaled steroid use.</p

Multivariate association of the central retinal vein equivalent (CRVE) and the forced expiratory volume in one second (FEV₁).

<p>The association of CRVE to the FEV₁ was linear in the fully adjusted model, and without evidence for a threshold effect. Covariates include age, gender, race/ethnicity, height, BMI, waist and hip circumference, cigarette smoking status, pack-years, urine cotinine, cigar-years, pipe-years, environmental tobacco exposure, occupational exposure to dust, asthma before age 45, family history of emphysema, chronic bronchitis, educational attainment, diabetes mellitus, fasting blood glucose, hypertension, systolic blood pressure, diastolic blood pressure, high-density lipoprotein, low-density lipoprotein, C reactive protein, fibrinogen, aspirin use, beta blocker use, angiotensin II receptor blocker and/or angiotensin converting enzyme inhibitor use, statin use, diuretic use, hormone replacement therapy use, bronchodilator use, and oral or inhaled steroid use. Dotted lines are 95% confidence intervals.</p

Mean differences in lung function and percent low attenuation area (%LAA) by retinal vascular caliber as measured by central retinal vein equivalent (CRVE).

<p>Abbreviations: SD = standard deviation; CRVE = Central Retinal Vein Equivalent; CI = confidence interval.</p>*<p>Includes 16 fewer participants than FEV₁ analysis.</p>†<p>Model 1: Adjusted for age, gender, race/ethnicity, body mass index, height, waist and hip circumference and, for CT analyses, CT scanner type.</p>‡<p>Model 2: Adjusted for all the variables in model 1 plus cigarette smoking status, cigarette pack years and urine cotinine.</p>§<p>Model 3: Adjusted for all the variables in model 2 plus cigar-years, pipe-years, environmental tobacco exposure, occupational exposure to dust, asthma before age 45, family history of emphysema, chronic bronchitis, educational attainment, diabetes mellitus, fasting blood glucose, hypertension, systolic blood pressure, diastolic blood pressure, high-density lipoprotein, low-density lipoprotein, C reactive protein, fibrinogen, aspirin use, beta blocker use, angiotensin II receptor blocker and/or angiotensin converting enzyme inhibitor use, statin use, diuretic use, hormone replacement therapy use, bronchodilator use, oral or inhaled steroid use.</p