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

Abstract 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 compe...

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Main Authors: Siyu Gui, Xinchen Wang, Qianqian Wang, Lan Zhong, Jianchao Qiao, Yueyang Xu, Yiran Li, Zhihao Huang, Chengyang Hu, Fangbiao Tao, Xiaodong Sun, Heting Liu, Jie Gao
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Language:English
Published: BMC 2025-03-01
Series:BMC Public Health
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Online Access:https://doi.org/10.1186/s12889-025-22249-7
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author Siyu Gui
Xinchen Wang
Qianqian Wang
Lan Zhong
Jianchao Qiao
Yueyang Xu
Yiran Li
Zhihao Huang
Chengyang Hu
Fangbiao Tao
Xiaodong Sun
Heting Liu
Jie Gao
author_facet Siyu Gui
Xinchen Wang
Qianqian Wang
Lan Zhong
Jianchao Qiao
Yueyang Xu
Yiran Li
Zhihao Huang
Chengyang Hu
Fangbiao Tao
Xiaodong Sun
Heting Liu
Jie Gao
author_sort Siyu Gui
collection DOAJ
description Abstract 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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spelling doaj-art-7f0b39fb923a4ac99ee6d718f028230b2025-08-20T03:40:44ZengBMCBMC Public Health1471-24582025-03-0125111210.1186/s12889-025-22249-7Association of nonrefractive visual impairment with risk of all-cause and specific-cause mortality in the National Health and Nutrition Examination Survey, 1999 to 2008Siyu Gui0Xinchen Wang1Qianqian Wang2Lan Zhong3Jianchao Qiao4Yueyang Xu5Yiran Li6Zhihao Huang7Chengyang Hu8Fangbiao Tao9Xiaodong Sun10Heting Liu11Jie Gao12Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Ophthalmology, The Second Affiliated Hospital of Anhui Medical UniversityDepartment of Ophthalmology, The Second Affiliated Hospital of Anhui Medical UniversityDepartment of Ophthalmology, Mingguang City People’s HospitalDepartment of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical UniversityDepartment of Clinical Medicine, The First School of Clinical Medicine, Anhui Medical UniversityDepartment of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical UniversityDepartment of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical UniversityDepartment of Humanistic Medicine, School of Humanistic Medicine, Anhui Medical UniversityDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical UniversityDepartment of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of MedicineDepartment of Ophthalmology, The Second Affiliated Hospital of Anhui Medical UniversityDepartment of Ophthalmology, The Second Affiliated Hospital of Anhui Medical UniversityAbstract 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.https://doi.org/10.1186/s12889-025-22249-7Visual impairmentAll-Cause mortalitySpecific-Cause mortality
spellingShingle Siyu Gui
Xinchen Wang
Qianqian Wang
Lan Zhong
Jianchao Qiao
Yueyang Xu
Yiran Li
Zhihao Huang
Chengyang Hu
Fangbiao Tao
Xiaodong Sun
Heting Liu
Jie Gao
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
BMC Public Health
Visual impairment
All-Cause mortality
Specific-Cause mortality
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Visual impairment
All-Cause mortality
Specific-Cause mortality
url https://doi.org/10.1186/s12889-025-22249-7
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