1. American Public Health Association San Francisco, California
Health-Related Quality of Life among People Aged ≥65 Years with Vision Impairment
John E. Crews, DPA
Chiu-Fang Chou, DrPH
Xinzhi Zhang, MD, PhD
Matthew M. Zack, MD, MPH
Jinan B. Saaddine, MD, MPH
American Public Health Association
San Francisco, California
October 31, 2012

2. Presenter Disclosure John E. Crews, DPA
The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: None.

3. Health Related Quality of Life and Vision
Considerable research on QoL and vision
Lack of clarity regarding what is meant by QoL.
Some investigation of Vision-Related QoL—focusing on vision functioning.
CDC developed standard set of HRQoL questions in BRFSS.
Previous investigation examined HRQoL and eye disease.
HRQoL: subjective measure of person's health and health perceptions

4. Objective
To assess the prevalence of self-reported Health Related Quality of Life measures among older adults (aged 65 years and older) by vision impairment status

5. Methods Data Set: BRFSS
Established 1984
Samples 350,000 people
World’s largest random-digit dialed telephone survey
Core question in all fifty states
HRQoL Measures in BRFSS core

6. BRFSS: Vision Module Administered in 23 states
10 questions—function, access, condition
Provides state level data
Began 2005; Discontinued for 2012.

7. Methods (Cont.) Data source and Sample Size:
BRFSS from 23 states
N=60,807 adults aged 65 and older
Outcome Variables: Six question HRQoL measures
Exposure Variable: Vision impairment status
no difficulty to both question,
little difficulty to either question, and
moderate or extreme difficulty or unable to do to either question.

8. Methods (Cont.) Covariates:
Race/ethnicity (Non-Hispanic white, Non-Hispanic black, Hispanic, and other)
Educational attainment (<HS, HS, and >HS)
Income (< $ 35,000, ≥ $ 35,000)
Age and sex
Statistical methods: Cross-tabulation; multivariate logistic regression
SAS version 9.2 with SUDAAN and Stata version to take account of the complex survey design

9. Vision Questions
How much difficulty, if any, do you have reading print in newspaper, magazine, recipe, menu, or numbers on the telephone?
How much difficulty, if any, do you have in recognizing a friend across the street?
Response categories: No difficulty, little difficulty, moderate difficulty, extreme difficulty, unable to do because of eyesight

10. HRQoL Questions
Self-Rated Health (excellent, very good, good, fair, poor)
Physically Unhealthy Days: “Now thinking about your physical health, which included physical illness and injury, for how many days during the past 30 was your physical health not good?
Mentally Unhealthy Days: Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”

11. HRQoL Questions
Activity Limitation Days: “During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?” Life Satisfaction: “In general, how satisfied are you with your life?” Disability: “Are you limited in any way in any activities because of physical, mental, or emotional problems?” and “Do you now have any health problems that requires you to us special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?”

12. Severity of Vision Impairment by Age Group

13. Severity of Vision Impairment by Sex

14. Severity of Vision Impairment by Race/Ethnicity

15. HRQoL Measures Life Satisfaction Disability Fair/Poor Health
Physically Unhealthy Days
Mentally Unhealthy Days
Activity Limitation Days

16. Life Dissatisfaction by the Severity of Vision Impairment

17. Disability by the Severity of Vision Impairment

18. Fair/Poor Health by the Severity of Vision Impairment

19. Unhealthy Days

20. Logistic Regression Fair/ Poor Health Life Dissatisfaction Disability
No VI
1.0
Little VI
1.17
1.61
1.45
Moderate/
Severe VI
1.80
2.29
2.01

21. Conclusions Poorer HRQoL associated with severity of vision loss.
Suggests importance of screening, diagnosis & treatment of eye disease, vision loss, refractive error
Suggests importance of health promotion interventions targeting people with little & moderate/severe vision of falls.

22. Recommendations
Health Promotion activities should address vision impairment as part of comprehensive strategies.
Modifying the environment to promote healthy activities: walks, street crossing, steps, lighting, labeling, signage
Improve access to eye and vision health
Improve access to health care and mental health care

23. Disclaimer
The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Center for Disease Control and Prevention.

24. Contact Information
For more information, please contact
John E. Crews, DPA at