Dataset Information

Mortality during 6 years of follow-up in relation to visual impairment and eye disease: results from a population-based cohort study of people aged 50 years and above in Nakuru, Kenya.

ABSTRACT: OBJECTIVE:To estimate the association between (1) visual impairment (VI) and (2) eye disease and 6-year mortality risk within a cohort of elderly Kenyan people. DESIGN, SETTING AND PARTICIPANTS:The baseline of the Nakuru Posterior Segment Eye Disease Study was formed from a population-based survey of 4318 participants aged ?50 years, enrolled in 2007-2008. Ophthalmic and anthropometric examinations were undertaken on all participants at baseline, and a questionnaire was administered, including medical and ophthalmic history. Participants were retraced in 2013-2014 for a second examination. Vital status was recorded for all participants through information from community members. Cumulative incidence of mortality, and its relationship with baseline VI and types of eye disease was estimated. Inverse probability weighting was used to adjust for non-participation. PRIMARY OUTCOME MEASURES:Cumulative incidence of mortality in relation to VI level at baseline. RESULTS:Of the baseline sample, 2170 (50%) were re-examined at follow-up and 407 (10%) were known to have died (adjusted risk of 11.9% over 6 years). Compared to those with normal vision (visual acuity (VA) ?6/12, risk=9.7%), the 6-year mortality risk was higher among people with VI (<6/18 to ?6/60; risk=28.3%; risk ratio (RR) 1.75, 95% CI 1.28 to 2.40) or severe VI (SVI)/blindness (<6/60; risk=34.9%; RR 1.98, 95% CI 1.04 to 3.80). These associations remained after adjustment for non-communicable disease (NCD) risk factors (mortality: RR 1.56, 95% CI 1.14 to 2.15; SVI/blind: RR 1.46, 95% CI 0.80 to 2.68). Mortality risk was also associated with presence of diabetic retinopathy at baseline (RR 3.18, 95% CI 1.98 to 5.09), cataract (RR 1.26, 95% CI 0.95 to 1.66) and presence of both cataract and VI (RR 1.57, 95% CI 1.24 to 1.98). Mortality risk was higher among people with age-related macular degeneration at baseline (with or without VI), compared with those without (RR 1.42, 95% CI 0.91 to 2.22 and RR 1.34, 95% CI 0.99 to 1.81, respectively). CONCLUSIONS:Visual acuity was related to 6-year mortality risk in this cohort of elderly Kenyan people, potentially because both VI and mortality are related to ageing and risk factors for NCD.

SUBMITTER: Kuper H

PROVIDER: S-EPMC6561440 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Mortality during 6 years of follow-up in relation to visual impairment and eye disease: results from a population-based cohort study of people aged 50 years and above in Nakuru, Kenya.

Kuper Hannah H Mathenge Wanjiku W Macleod David D Foster Allen A Gichangi Michael M Rono Hillary H Wing Kevin K Weiss Helen Anne HA Bastawrous Andrew A Burton Matthew M

BMJ open 20190609 6

<h4>Objective</h4>To estimate the association between (1) visual impairment (VI) and (2) eye disease and 6-year mortality risk within a cohort of elderly Kenyan people.<h4>Design, setting and participants</h4>The baseline of the Nakuru Posterior Segment Eye Disease Study was formed from a population-based survey of 4318 participants aged ≥50 years, enrolled in 2007-2008. Ophthalmic and anthropometric examinations were undertaken on all participants at baseline, and a questionnaire was administer ...[more]

PMID: 31182456

Similar Datasets

Project description:This study aimed to investigate the epidemiology of low-energy lower-extremity fracture in Chinese men and women aged 50 years and above. This study was a part of Chinese National Fracture Survey (CNFS), which used the stratified multistage cluster random sampling method to recruit subjects between January and May 2015. A total of 512187 individuals participated in the CNFS and of them there were 154099 men and women aged 50 years and above included in this study for data analysis. Low-energy fracture was defined as a fracture caused by slip, trip or fall from standing height. Univariate analyses and gender-based multivariate logistic regression models were constructed to identify the independent risk factors. A total of 215 patients had sustained low-energy lower extremity fractures in 2014, indicating the overall incidence was 139.5 (120.9 to 158.2) per 100000 persons, with 127.8 (102.5 to 153.1) and 151.1 (123.8 to 178.5) per 100000 person-year in men and women. Over 80% of fractures occurred at home and on the common road. In men, alcohol consumption (OR, 2.00; 95%CI, 1.29 to 3.08), sleep duration<7h/d (OR, 2.60; 95%CI, 1.68 to 4.03) and history of past fracture (OR, 2.57; 95%CI, 1.33 to 4.95) were identified as significant risk factors associated with low-energy fractures. In women, advanced age (80+ years) (OR, 3.22; 95%CI, 1.80 to 5.75), alcohol consumption(OR, 1.72; 95%CI, 1.00 to 2.98), sleep duration <7h/d (OR, 2.11; 95%CI, 1.40 to 3.18), and history of past fracture (OR, 3.46; 95%CI, 1.97 to 6.09) were identified as significant risk factors and living in western region (OR, 0.60; 95%CI, 0.38 to 0.94) and current weight of 50 to 59.9 kg (OR, 0.17; 95%CI, 0.04 to 0.73) were identified as protective factors for fractures. Accordingly, awareness on the importance of sleep and alcohol consumption on fragility fracture should be improved, and health policies that focus on decreasing alcohol consumption and encouraging individuals to improve their sleep quality and duration should be considered. Maintaining a healthy bodyweight for women should be specifically emphasized to prevent low-energy fractures.

Project description:Importance:Contemporary data on use of eye care by US adults are critical, as the prevalence of age-related eye disease and vision impairment are projected to increase in the coming decades. Objectives:To provide nationally representative estimates on self-reported use of eye care by adults aged 50 to 80 years, and to describe the reasons that adults do and do not seek eye care. Design, Setting, and Participants:The National Poll on Healthy Aging, a cross-sectional, nationally representative online survey was conducted from March 9 to 24, 2018, among 2013 individuals aged 50 to 80 years. Main Outcomes and Measures:The proportion of US adults who received an eye examination within the past 2 years as well as the sociodemographic and economic factors associated with receipt of eye care. Results:Among 2013 adults aged 50 to 80 years (survey-weighted proportion of women, 52.5%; white non-Hispanic, 71.1%; mean [SD] age, 62.1 [9.0] years), the proportion reporting that they underwent an eye examination in the past year was 58.5% (95% CI, 56.1%-60.8%) and in the past 2 years was 82.4% (95% CI, 80.4%-84.2%). Among those with diabetes, 72.2% (95% CI, 67.2%-76.8%) reported undergoing an eye examination in the past year and 91.3% (95% CI, 87.7%-93.9%) in the past 2 years. The odds of having undergone an eye examination within the past 2 years were higher among women (adjusted odds ratio [AOR], 2.00; 95% CI, 1.50-2.67), respondents with household incomes of $30?000 or more (AOR, 1.57; 95% CI, 1.08-2.29), and those with a diagnosed age-related eye disease (AOR, 3.67; 95% CI, 2.37-5.69) or diabetes (AOR, 2.30; 95% CI, 1.50-3.54). The odds were lower for respondents who were unmarried (AOR, 0.71; 95% CI, 0.53-0.96), from the Midwest (AOR, 0.55; 95% CI, 0.34-0.87) or West (AOR, 0.60; 95% CI, 0.38-0.94), or reported fair or poor vision (AOR, 0.43; 95% CI, 0.28-0.65). Reasons reported for not undergoing a recent eye examination included having no perceived problems with their eyes or vision (41.5%), cost (24.9%), or lack of insurance coverage (23.4%). Conclusions and Relevance:In this study, the rate of eye examinations was generally high among US adults aged 50 to 80 years, yet there were several significant demographic and socioeconomic differences in the use of eye care. These findings may be relevant to health policy efforts to address disparities in eye care and to promote care for those most at risk for vision problems.

Project description:ImportanceThe incidence of age-related macular degeneration (AMD) is unknown in Africa.ObjectiveTo estimate the 6-year cumulative incidence and progression of AMD in older adults (≥50 years old) in Nakuru, Kenya.Design, setting, and participantsThis study assessed a population-based cohort with 6-year follow-up of 4414 participants who had a complete assessment. Random cluster sampling with probability proportionate to size procedures was used to select a representative, cross-sectional sample of adults 50 years and older from January 26, 2007, through November 11, 2008. A 6-year follow-up was undertaken from January 7, 2013, through March 12, 2014. On both occasions, a comprehensive ophthalmic examination was performed that included logMAR visual acuity, digital retinal photography, and grading of images at Moorfields Eye Hospital Reading Centre. Data were collected on general health and risk factors.Main outcomes and measuresIncident AMD in participants with no AMD at baseline and progression from early to late AMD.ResultsA total of 1453 of the 2900 individuals (50.1%) at risk for AMD were followed up after 6 years (mean [SD] age, 60.7 [8.2] years; 635 female [49.5%]; 799 Kikuyu [62.3%], 324 Kalenjin [25.3%], and 159 other [12.4%]); 1282 had data on AMD status at follow-up. Of these, 202 developed early AMD, and no participants developed late AMD. The 6-year weighted (for loss to follow-up) cumulative incidence of early AMD was 164.2 per 1000 persons (95% CI, 136.7-195.9 per 1000 persons). Two individuals with baseline early AMD from the 142 at risk had developed late AMD at follow-up, with a 6-year cumulative incidence of progression from early to late AMD of 24.5 per 1000 persons (95% CI, 5.0-111.7 per 1000 persons). Cumulative incidence of AMD increased with age (≥80 years old vs 50-59 years old: 1.8; 95% CI, 0.9-3.5) and was higher in women (female vs male: 1.6; 95% CI, 1.2-2.1) and persons with diabetes (diabetes vs no diabetes: 1.7; 95% CI, 1.0-2.8).Conclusions and relevanceIn Kenya, more than 100 000 estimated new cases of AMD, mainly early AMD, will develop every year in individuals 50 years or older, although a 50% loss to follow-up and wide CIs for progression to late AMD limit definitive conclusions from these findings.

Project description:The majority of the older Singaporean women aged 50 years and above are physically inactive and have unhealthy dietary habits, placing them at 'high risk' of non-communicable diseases (NCDs). The adoption of regular physical activity (PA) and a healthy diet are essential lifestyle behaviours to reduce this risk. This randomised controlled trial (RCT) involves the development, implementation and evaluation of a PA and nutrition programme for community-dwelling Singaporean women who currently attend recreational centres (RCs are public facilities supporting social leisure activities) in their local area. The intervention will be developed after conducting formative evaluation with RC attendees and managers through focus group discussions and pilot testing of resources (i.e. surveys, accelerometers, and health booklets). Programme ambassadors (trained, certified fitness instructors and nutritionists) will deliver all sessions in English and Mandarin; implement classes to meet participants' varying needs; and conduct sessions at different times at convenient venues. Social Cognitive Theory (SCT) has been selected as the theoretical framework to inform intervention strategies as it explores the interactions of human behaviour with the environment and has been found to be valuable when developing behavioural change interventions particularly in older adults (J Gerontol B Psychol Sci Soc Sci 67B(1):18-26, 2012; Obesity Reviews 15(12):983-95, 2014). Its major construct, self-efficacy, is invaluable in achieving successful behaviour change, such as increasing levels of PA or improving dietary intake (Trials. 2017; https://doi.org/10.1186/s13063-016-1771-9 ; Psychol Health Med 18(6):714-24, 2013).The development and implementation of the PA and nutrition intervention strategies will be guided by SCT and Motivational interviewing (MI) and implemented by trained programme ambassadors at the RCs. Sixty RCs located in Singapore will be selected from five major geographical districts and randomly allocated to the intervention (n = 30) or control (n = 30) cluster. A sample of 600 (intervention n = 300; control n = 300) women aged 50 years and above will then be recruited from these 60 centres and only the intervention group will be enrolled into the PA and nutrition intervention. It is hypothesised that by the end of the intervention, the intervention group participants compared to the control group will show significantly greater improvements in the following outcome variables: PA and dietary behaviours, health-related quality of life, objective measures of PA, anthropometric, lipid and glucose profiles. Data will be collected at baseline and 6 months and analysed using mixed regression models.It is anticipated that recruitment, retention and compliance of participants will be challenging due to the target group being unfamiliar with such community-based research programmes.Australian and New Zealand Clinical Trials Registry, ACTRN12617001022358. Registered on 14 July 2017. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372984&isReview=true.

Project description:Objective: Chronic Subdural Hematoma (cSDH) is primarily a disease of elderly, and is rare in patients <50 years, and this may in part be related to the increased brain atrophy from 50 years of age. This fact may also influence clinical presentation and outcome. The aim of this study was to study the clinical course with emphasis on clinical presentation of cSDH patients in the young (<50 years). Methods: A retrospective review of a population-based cohort of 1,252 patients operated for cSDH from three Scandinavian neurosurgical centers was conducted. The primary end-point was difference in clinical presentation between the patients <50 y/o and the remaining patients (≥50 y/o group). The secondary end-points were differences in perioperative morbidity, recurrence and mortality between the two groups. In addition, a meta-analysis was performed comparing clinical patterns of cSDH in the two age groups. Results: Fifty-two patients (4.2%) were younger than 50 years. Younger patients were more likely to present with headache (86.5% vs. 37.9%, p < 0.001) and vomiting (25% vs. 5.2%, p < 0.001) than the patients ≥50 y/o, while the ≥50 y/o group more often presented with limb weakness (17.3% vs. 44.8%, p < 0.001), speech impairment (5.8% vs. 26.2%, p = 0.001) and gait disturbance or falls (23.1% vs. 50.7%, p < 0.001). There was no difference between the two groups in recurrence, overall complication rate and mortality within 90 days. Our meta-analysis confirmed that younger patients are more likely to present with headache (p = 0.015) while the hemispheric symptoms are more likely in patients ≥50 y/o (p < 0.001). Conclusion: Younger patients with cSDH present more often with signs of increased intracranial pressure, while those ≥50 y/o more often present with hemispheric symptoms. No difference exists between the two groups in terms of recurrence, morbidity, and short-term mortality. Knowledge of variations in clinical presentation is important for correct and timely diagnosis in younger cSDH patients.

Dataset Information

Mortality during 6 years of follow-up in relation to visual impairment and eye disease: results from a population-based cohort study of people aged 50 years and above in Nakuru, Kenya.

Publications

Mortality during 6 years of follow-up in relation to visual impairment and eye disease: results from a population-based cohort study of people aged 50 years and above in Nakuru, Kenya.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets