RESUMEN
Purpose: To assess the impact of retinopathy and systemic vascular comorbidities on the all-cause mortality in a representative U.S. sample. Methods: A total of 5703 participants (≥40 years old) from the 2005-2008 National Health and Nutrition Examination Survey. The Early Treatment Diabetic Retinopathy Study grading scale was used to evaluate the retinopathy status. Systemic vascular comorbidities included diabetes mellitus (DM), high blood pressure (HBP), chronic kidney disease (CKD) and cardiovascular disease (CVD). Time to death was calculated as the time from baseline to either the date of death or censoring (December 31st, 2015), whichever came first. Risks of mortality were estimated using Cox proportional hazards models after adjusting for confounders and vascular comorbidities. Results: After a median follow-up of 8.33 years (IQR: 7.50-9.67 years), there were 949 (11.8%) deaths from all causes. After adjusting for confounders, the presence of retinopathy predicted higher all-cause mortality (hazard ratio (HR), 1.41; 95% confidence interval (CI), 1.08-1.83). The all-cause mortality among participants with both retinopathy and systemic vascular comorbidities including DM (HR, 1.72; 95% CI, 1.21-2.43), HBP (HR, 1.47; 95% CI, 1.03-2.10), CKD (HR, 1.73; 95% CI, 1.26-2.39) and CVD (HR, 1.92; 95% CI, 1.21-3.04) was significantly higher than that among those without either condition. When stratified by diabetic or hypertension status, the co-occurrence of retinopathy and CKD or CVD further increased the all-cause mortality compared to those without either condition. Conclusions: The co-occurrence of retinopathy and systemic vascular conditions predicted a further increase in the risk of mortality. More extensive vascular risk factor assessment and management are needed to detect the burden of vascular pathologies and improve long-term survival in individuals with retinopathy.
Asunto(s)
Angiopatías Diabéticas/mortalidad , Retinopatía Diabética/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Diabetes Mellitus/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Insuficiencia Renal Crónica/mortalidad , Medición de Riesgo , Factores de Riesgo , Factores Socioeconómicos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: To evaluate impacts of cognitive impairment and systemic vascular comorbidities on hazards of all-cause and cardiovascular mortality in a representative United States population. METHODS: Subjects aged ≥60 years from two waves of National Health and Nutrition Examination Survey were analyzed. Cognitive function was evaluated by Digit Symbol Substitution Test. Systemic vascular comorbidities included diabetes mellitus (DM), chronic kidney disease (CKD), high blood pressure (HBP) and hypotension. Hazards of all-cause and cardiovascular mortality were estimated with Cox proportional hazard regression models. RESULTS: After a median follow-up of 9.83 years, 937 (35.6%) and 247 (8.6%) deaths caused by all causes and cardiovascular diseases, respectively. After adjusting for confounders, cognitive impairment predicted a higher risk of all-cause mortality (Hazard Ratios (HR), 2.00; 95% confidence interval (CI), 1.62-2.46) and cardiovascular mortality (HR, 1.79; 95% CI, 1.27-2.53). Risk of all-cause mortality was further increased among those with cognitive impairment concomitant with DM (HR, 2.24; 95% CI, 1.61-3.13), CKD (HR, 2.56; 95% CI, 1.77-3.67), HBP (HR, 2.57; 95% CI, 1.73-3.84) or hypotension (HR, 2.38; 95% CI, 1.78-3.18). Co-presence of cognitive impairment with DM (HR, 2.30; 95% CI, 1.25-4.26), CKD (HR, 2.56; 95% CI, 1.35-4.88), HBP (HR, 4.65; 95% CI, 2.28-9.46) or hypotension (HR, 2.69; 95% CI, 1.67-4.31) also posed a significant higher risk of cardiovascular mortality than participants with neither condition. INTERPRETATION: Cognitive impairment concomitant with other systemic vascular comorbidities predicted further increased risks of mortality. More extensive assessments and management of cognitive function and systemic vascular comorbidities are warranted.