Cardiovascular Health and Near Visual Impairment Among Older Adults in the Republic of Congo: A Population-Based Study

Visual Impairment and Its Associated Factors Among Hypertensive Patients in Amhara Region Referral Hospitals, Ethiopia

Background

Visual impairment is one of the most common long-term effects of high blood pressure. It affects one's quality of life, independence, and mobility. There is a paucity of information regarding the prevalence of visual impairment due to hypertension in Ethiopia. Therefore, this study aimed to determine the prevalence of visual impairment and its associated factors among hypertensive patients in referral hospitals of the Amhara region, Ethiopia, 2021.

Methods

An institution-based cross-sectional study was conducted among 423 study participants, which were selected by systematic random sampling technique. Data were collected by using an interviewer-administered structured questionnaire and physical measurements. The collected data were entered into Epi-data version 4.6. Then, exported into SPSS Version 26 for analysis. The crude and adjusted odds ratios and 95% Confidence intervals were calculated. Both bivariable and multivariable logistic regression analyses were done. Variables with a p-value of ≤0.05 were stated as significantly associated with visual impairment.

Results

The overall prevalence of visual impairment among hypertensive patients was 32.4% (95% CI: 27.9-37.9). Duration of hypertension ≥ 5 years (AOR =3.06, 95% CI: 1.86-4.95), history of ocular trauma (AOR =2.50, 95% CI: 1.3-4.73), and ever alcohol drinking (AOR = 2.72, 95% CI: 1.32-5.62) were significantly associated with visual impairment.

Conclusion

Nearly one-third of hypertensive patients were visually impaired from the study participants. Duration of hypertension ≥5 years, history of ocular trauma, and ever alcohol drinking was significantly associated with visual impairment among hypertensive patients. Therefore, in addition to providing medical care and follow-up services for hypertension patients, health education is needed for early and proper management of visual impairment, and to decrease their level of alcohol consumption. Furthermore, better to do this study by prospective cohort study design to identify cause-and-effect relationships.

Associations of hospitalisation - admission, readmission and length to stay - with multimorbidity patterns by age and sex in adults and older adults: the ELSI-Brazil study

BACKGROUND

Although the association between multimorbidity (MM) and hospitalisation is known, the different effects of MM patterns by age and sex in this outcome needs to be elucidated. Our study aimed to analyse the association of hospitalisations' variables (occurrence, readmission, length of stay) and patterns of multimorbidity (MM) according to sex and age.

METHODS

Data from 8.807 participants aged ≥ 50 years sourced from the baseline of the Brazilian Longitudinal Study of Ageing (ELSI-Brazil) were analysed. Multimorbidity was defined as ≥ 2 (MM2) and ≥ 3 (MM3) chronic conditions. Poisson regression was used to verify the association between the independent variables and hospitalisation according to sex and age group. Multiple linear regression models were constructed for the outcomes of readmission and length of stay. Ising models were used to estimate the networks of diseases and MM patterns.

RESULTS

Regarding the risk of hospitalisation among those with MM2, we observed a positive association with male sex, age ≥ 75 years and women aged ≥ 75 years. For MM3, there was a positive association with hospitalisation among males. For the outcomes hospital readmission and length of stay, we observed a positive association with male sex and women aged ≥ 75 years. Network analysis identified two groups that are more strongly associated with occurrence of hospitalisation: the cardiovascular-cancer-glaucoma-cataract group stratified by sex and the neurodegenerative diseases-renal failure-haemorrhagic stroke group stratified by age group.

CONCLUSION

We conclude that the association between hospitalisation, readmission, length of stay, and MM changes when sex and age group are considered. Differences were identified in the MM patterns associated with hospitalisation according to sex and age group.

Changes in Health Care Utilization and Medical Expenditures among the Visually Disabled

Purpose: To identify changes in medical expenditures and health care utilization before and after visual impairment onset, then analyze differences according to visual impairment severity.Methods: Patients aged ≥ 18 years who were registered as visually disabled from 2005 to 2013 were selected using the database from the registry of the disabled and the National Health Insurance Service. The observation period of 3 years before and after the registration was divided into 6-month units (12 points of interest). At each point of interest, medical cost, number of outpatient visits, and length of hospital stay (LOS) were analyzed. The control group was obtained through 1:10 stratification randomization to match sex and age; individuals in the control group were then selected via 1:1 propensity score matching for the premium quantile and residential area.Results: In total, 131,434 patients with visual disability and the same number of non-visually impaired controls were included. Compared with non-disabled individuals, the mean medical cost and number of outpatient visits were higher for patients with visual disability (1.9- and 1.4-fold, respectively, p < 0.001); the LOS was also 3.5 days longer (p < 0.001). The mean medical cost and number of outpatient visits were greater in severely visually disabled patients than in mildly disabled patients (1.6- and 0.5-fold, respectively, p < 0.001); the LOS was also 12 days longer in severely disabled patients (p < 0.001). From 18 months before disability registration, medical costs and LOS increased according to the presence and severity of visual disability; the number of outpatient visits increased uniformly, regardless of disability and severity.Conclusions: More severe cases of visual impairment are associated with greater health care utilization and expenditures. Policy intervention is necessary to ensure that patients receive appropriate treatment and steady health care by reducing the burden of medical expenditures.

Changes in Incidences of Chronic and Traumatic Diseases before and after Registration as Visually Disabled

Purpose: To analyze changes in the incidences of chronic and traumatic diseases before and after registration as visually disabled.Methods: The incidence and risk of chronic and traumatic diseases were compared between patients registered as visually disabled from 2005 to 2013 and a control group, selected through 1:1 propensity score matching for age, sex, premium quantile, and residential area distribution. Data from the National Health Insurance Service were used and the observation period was set from 2 years before to 5 years after the time of registration as visually disabled. The incidences (%) of chronic and traumatic diseases at the point of interest were determined as the mean values according to year of registration, and the risk was measured by conditional logistic regression analysis.Results: 131,434 visually disabled patients and the same number of non-visually impaired controls were included. The incidences of chronic disease and fall-related injury were higher in the visually disabled group before registration, but gradually decreased and became similar to the control group after registration. In addition, the risk of developing chronic diseases was higher in the visually disabled group until 2 years after registration, while the risk of fall-related injury remained consistently higher in the visually disabled group during the observation period. The incidence and risk of hip fracture in the visually disabled group increased gradually from approximately 1 year before registration and remained consistently higher than in the control group.Conclusions: People with visual disability have higher incidences of chronic diseases than do non-visually impaired people and are at greater risk of traumatic injuries, such as hip fractures or falls. There is a need to establish community infrastructure and expand welfare services for the prevention and early treatment of comorbidities, both for patients with registered visual disabilities and for patients who have not yet registered.