Vision Impairment in the National Health and Aging Trends Study: Epidemiology, Social Determinants of Health, and Adverse Late Life Outcomes
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PROJECT SUMMARY/ABSTRACT At least 14 million people in the U.S. are blind or living with a vision impairment (VI), and the number affected is projected to double by 2050 due to aging and growth of the U.S. population. The majority of those with VI and blindness are older adults aged ≥65 years. Racial and ethnic minorities are also disproportionately affected, in part due to social determinants of health (SDoH) like healthcare access, economic stability, and features of the built environment. Particularly in later life, VI is thought to be associated with a host of adverse outcomes, including dementia, admission to a long-term care facility, and even mortality. Nonetheless, rigorous and generalizable research on how SDoH impact vision and eye health, and how vision influences late-life outcomes has been limited due to a lack of data that: (i) is longitudinal; (ii) is representative of the U.S. population; (iii) contains objective assessments of visual function; and (iv) samples older adults. In the proposed project, we will address this barrier using newly collected vision data from the NIH-funded National Health and Aging Trends Study (NHATS), an ongoing nationally representative panel study of >7,000 adults aged ≥65 years. In 2021, NHATS began annual measurement of distance and near visual acuity and contrast sensitivity. In Aim 1 of the proposed study, we use NHATS data to provide the first-ever estimates on the incidence of VI and blindness at the national level, as well as national prevalence estimates stratified by age, sex, and race and ethnicity. In Aim 2, we will evaluate the longitudinal influence of SDoH on vision health. To do so, we will utilize individual-level indicators of SDoH from NHATS, and neighborhood level-indicators from the NIH-funded National Neighborhood Data Archive that is linked to NHATS. In Aim 3, we will investigate the longitudinal impact of VI and blindness on the development of dementia, placement in long-term care, and all-cause mortality. In a sub-aim, we will use a longitudinal mediation model to test whether the influence of SDoH on adverse late-life outcomes is mediated by vision and eye health. To date, it has not been possible to carry out nationally representative studies on the associations of VI with SDoH and key late-life outcomes due to the lack of longitudinal and objectively measured visual function data in a national sample. Thus, the proposed studies will address critical scientific gaps. This proposal is also highly responsive to the National Eye Institute’s new 5-year Strategic Plan, including: (i) to gather current epidemiologic data; (ii) to support research at the nexus of SDoH and the healthcare system; and (iii) to explore research encompassing comorbidities. Epidemiological estimates will be made publicly available and all study findings will be widely disseminated to maximize the impact of these studies on public health and policy and to optimize vision and overall health and wellbeing for an aging U.S. population.
