HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) All Versions of this Article: AJPH.2004.056671v1 95/11/1940    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (13) Citing Articles via Google Scholar Google Scholar Articles by Caban, A. J. Articles by Zheng, D. D. Search for Related Content PubMed PubMed Citation Articles by Caban, A. J. Articles by Zheng, D. D. Related Collections Other Chronic Disease Epidemiology Other Race/Ethnicity Surveillance Surveys

Alberto J. Caban, MPH, David J. Lee, PhD, Orlando Gómez-Marín, MSc, PhD, Byron L. Lam, MD and D. Diane Zheng, MSc

Alberto J. Caban is with the Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, Fla, and Nova Southeastern University College of Osteopathic Medicine Master of Public Health Program, Fort Lauderdale, Fla. David J. Lee, Orlando Gómez-Marín, and Diane Zheng are with the Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine. Byron L. Lam is with the Department of Ophthalmology, University of Miami, Miller School of Medicine.

Correspondence: Requests for reprints should be sent to David J. Lee, University of Miami School of Medicine, 1801 NW 9th Ave, Highland Professional Building, Suite 200, Miami, FL 33136 (e-mail: dlee{at}med.miami.edu).

	ABSTRACT

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 

Analysis of data from a nationally representative sample of US adults (n=195801) showed that concurrent hearing and visual impairment prevalence rates were highest for participants older than 79 years of age (16.6%); a 3-fold increase in age-adjusted rates of reported hearing and visual impairment was observed for Native Americans compared with Asian Americans. Research on preventing concurrent hearing and visual impairment and countering its consequences is warranted, especially in population subgroups, such as Native and older Americans.

	INTRODUCTION

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
Hearing impairment (HI), visual impairment (VI), and concurrent impairment (HI+VI) have marked effects on cognitive, psychosocial, and functional health and even on the risk of mortality.^1–8 There is some evidence that the presence of more than 1 sensory impairment increases morbidity risk relative to VI or HI alone.^4,9 Despite continued improvements in the health and disability status of older US adults, there is no evidence that VI or HI rates reported by adults are declining.^10,11 Unfortunately, prevalence estimates of HI+VI determined via clinical assessment are not available for the US population. This article uses nationally representative data from the National Health Interview Survey (NHIS) to assess the prevalence of HI+VI in community-residing US adults, aged 18 years and older.

	METHODS

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
The NHIS is an annual, continuous, multi-purpose, and multistage probability cross-sectional survey of the US civilian noninstitutionalized population and is conducted by the National Center for Health Statistics.^12,13 A probability sample of households is selected with family members interviewed by trained personnel; 1 adult from each household is selected at random and administered a health-oriented questionnaire (i.e., "the adult core"), which includes questions about HI and VI. Annual response rates to the 1997 to 2002 adult core ranged from 70% (in 1999) to 80% (in 1997).^14–19 More than 195000 adult participants of the 1997 to 2002 NHIS were administered the following questions: (1) "Do you have any trouble seeing, even when wearing glasses or contact lenses?"; (2) "Are you blind or unable to see at all?"; and (3) "Which statement best describes your hearing (without a hearing aid): good, a little trouble, a lot of trouble, deaf." Participants responding yes to either of the first 2 questions were considered to be visually impaired. Participants reporting a little trouble, a lot of trouble, or that they were deaf were classified as hearing impaired.

Analyses were completed using the Software for the Statistical Analysis of Correlated Data (Research Triangle Institute, Research Triangle Park, NC) package to take into account sample weights and design effects.²⁰ Sample weights were adjusted to account for the aggregation of data over multiple survey years.²¹ Subgroup prevalence rates were compared using approximate Z tests; trend analyses were used for age-group-specific rates. When comparing more than 2 groups, P values were adjusted using Bonferroni’s approach for multiple comparisons. Age-adjusted rates of VI only, HI only, and HI+VI were calculated by the direct method using the 2000 US Census population as the standard.²²

	RESULTS

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
Overall prevalence rates of HI only were approximately twice as those of VI only (Table 1, 13.1 vs 6.0). The overall prevalence of HI+VI was 3.3% and increased from 1.3% for participants aged 18–44 years to 16.6% for participants aged 80 years or older (P for trend <.01). Age-adjusted rates of HI+VI were slightly but significantly higher in men versus women (3.6% vs 3.2%; P<.001), in adults with less than a 12th grade education versus adults with more than a 12th grade education (4.9% vs 2.8%; P<0.001), and in nonmarried versus married adults (4.1% vs 2.9%; P<.001). Aleut, Eskimo, and American Indians reported more than 3 times the rate of HI+VI relative to Asian/Pacific Islander Americans (6.3% vs 1.8%; P<.001); rates for Aleut, Eskimo, and American Indians were also significantly greater than for any of the other race groups (all P values <.01).

	DISCUSSION

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

More than 16% of adults aged 80 years or older report HI+VI, and census projections indicate that the size of this segment of the US population will increase 25% in the next 15 years.²⁶ Therefore, these impairments will pose important challenges for increasing numbers of families and family caregivers in the coming years.²⁷ The correction of visual and hearing deficits improves quality of life and is associated with reduced risk of mortality,^2,28,29 yet routine coverage for many of these services is not provided by Medicare (e.g., corrective lenses and hearing aids). Policymakers should vigorously pursue expansion of such coverage.

Finally, it is unknown why Aleut, Eskimo, and Native Americans have significantly higher rates of HI+VI, but this may be because of limited health care access,³⁰ possibly in combination with increased risks of auditory disorders^31–33 and angle closure glaucoma.^34,35 Additional research in this race group is clearly warranted given the paucity of studies on these impairments in this diverse and understudied race group.^36–38

	Acknowledgments

 
This study was supported in part by the National Institute on Aging (grant R01 AG021627).

The data used in this publication were made available in part by the Inter-University Consortium for Political and Social Research. The data for the National Health Interview Survey were originally collected and prepared by the US Department of Health and Human Services and the National Center for Health Statistics. Neither the collector of the original data nor the Consortium bears any responsibility for the analyses or interpretations presented in this publication.

Human Participant Protection
The protocol was reviewed and approved for exemption by the institutional review board of the University of Miami, Miller School of Medicine, because this study uses anonymous data from a publicly available database.

	Footnotes

 
Peer Reviewed

Contributors
A. J. Caban, D. J. Lee, and B. L. Lam originated the study and led the writing of this paper. O. Gomez-Marin and D. D. Zheng managed the data and performed statistical analyses. All authors helped conceptualize ideas, interpret findings, and provide critical review of this paper.

Accepted for publication January 3, 2005.

	References

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
1. Appollonio I, Carabellese C, Magni E, Frattola L, Trabucchi M. Sensory impairments and mortality in an elderly community population: a six-year follow-up study. Age Ageing. 1995;24:30–36.[Abstract/Free Full Text]

2. Appollonio I, Carabellese C, Frattola L, Trabucchi M. Effects of sensory aids on the quality of life and mortality of elderly people: a multivariate analysis. Age Ageing. 1996;25:89–96.[Abstract/Free Full Text]

3. Campbell VA, Crews JE, Moriarty DG, Zack MM, Blackman DK. Surveillance for sensory impairment, activity limitation, and health-related quality of life among older adults—United States, 1993–1997. MMWR CDC Surveill Summ. 1999;48:131–156.[Medline]

4. Keller BK, Morton JL, Thomas VS, Potter JF. The effect of visual and hearing impairments on functional status. J Am Geriatr Soc. 1999;47:1319–1325.[Web of Science][Medline]

5. Lupsakko T, Mantyjarvi M, Kautiainen H, Sulkava R. Combined hearing and visual impairment and depression in a population aged 75 years and older. Int J Geriatr Psychiatry. 2002;17:808–813.[CrossRef][Web of Science][Medline]

6. Reuben DB, Mui S, Damesyn M, Moore AA, Greendale GA. The prognostic value of sensory impairment in older persons. J Am Geriatr Soc. 1999;47:930–935.[Web of Science][Medline]

7. Crews JE, Campbell VA. Vision impairment and hearing loss among community-dwelling older Americans: implications for health and functioning. Am J Public Health. 2004;94:823–829.[Abstract/Free Full Text]

8. LaForge RG, Spector WD, Sternberg J. The Relationship of vision and hearing impairment to one-year mortality and functional decline. J Aging Health. 1992; 4:126–148.[Abstract/Free Full Text]

9. Carabellese C, Appollonio I, Rozzini R, et al. Sensory impairment and quality of life in a community elderly population. J Am Geriatr Soc. 1993;41:401–407.[Web of Science][Medline]

10. Lee DJ, Gómez-Marín O, Lam BL, Zheng DD, Jane DM. Trends in visual acuity impairment in US adults: the 1986–1995 National Health Interview Survey. Arch Ophthalmol. 2004;122:506–509.[Abstract/Free Full Text]

11. Lee DJ, Gómez-Marín O, Lam BL, Zheng DD. Trends in hearing impairment in United States adults: the National Health Interview Survey, 1986–1995. J Gerontol A Biol Sci Med Sci. 2004;59:1186–1190.[Abstract/Free Full Text]

12. Botman SL, Moore TF, Moriarty CL, Parsons VL. Design and estimation for the National Health Interview Survey, 1995–2004. Vital Health Stat 2. 2000; 130:1–31.

13. Fowler FJ, Jr. The redesign of the National Health Interview Survey. Public Health Rep. 1996;111:508–511.[Web of Science][Medline]

14. Blackwell DL, Collins JG, Coles R. Summary health statistics for US. adults: National Health Interview Survey, 1997. Vital Health Stat. 2002;10:1–110.

15. Pleis JR, Coles R. Summary health statistics for US. adults: National Health Interview Survey, 1998. Vital Health Stat. 2002;10:1–121.

16. Pleis JR, Coles R. Summary health statistics for US. adults: National Health Interview Survey, 1999. Vital Health Stat. 2003;10:1–145.

17. Pleis JR, Benson V, Schiller JS. Summary health statistics for US. adults: National Health Interview Survey, 2000. Vital Health Stat. 2003;10:1–141.

18. Lucas JW, Schiller JS, Benson V. Summary health statistics for US. adults: National Health Interview Survey, 2001. Vital Health Stat. 2004;10:1–143.

19. Lethbridge-Cejku M, Schiller JS, Bernadel L. Summary health statistics for US. adults: National Health Interview Survey, 2002. Vital Health Stat. 2004;10:1–160.

20. Research Triangle Institute. Software for Survey Data Analysis (SUDAAN) Version 8.0.2. Research Triangle Park, NC: Research Triangle Institute; 2004.

21. Botman SL, Jack SS. Combining National Health Interview Survey Datasets: issues and approaches. Stat Med. 1995;14:669–677.[Web of Science][Medline]

22. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected US. population. In: Healthy People 2010 Statistical Notes. Number 20. Atlanta, GA: Centers for Disease Control and Prevention; 2001.

23. Sindhusake D, Mitchell P, Smith W, et al. Validation of self-reported hearing loss. The Blue Mountains Hearing Study. Int J Epidemiol. 2001;30:1371–1378.[Abstract/Free Full Text]

24. Mangione CM, Lee PP, Gutiérrez PR, Spritzer K, Berry S, Hays RD. Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol. 2001;119:1050–1058.[Abstract/Free Full Text]

25. Mangione CM, Lee PP, Pitts J, Gutiérrez P, Berry S, Hays RD. Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ). NEI-VFQ Field Test Investigators. Arch Ophthalmol. 1998;116:1496–1504.[Abstract/Free Full Text]

26. National Population Projections I. Summary Files Total Population by Age, Sex, Race, and Hispanic Origin. Washington, DC: US Census Bureau; 2004.

27. Crews JE, Frey WD. Family concerns and older-people who are blind. J Vis Impair Blind. 1993;87:6–11.[Web of Science]

28. Mulrow CD, Aguilar C, Endicott JE, et al. Quality-of-life changes and hearing impairment. A randomized trial. Ann Intern Med. 1990;113:188–194.

29. Applegate WB, Miller ST, Elam JT, Freeman JM, Wood TO, Gettlefinger TC. Impact of cataract surgery with lens implantation on vision and physical function in elderly patients. JAMA. 1987;257:1064–1066.[Abstract/Free Full Text]

30. Zuckerman S, Haley J, Roubideaux Y, Lillie-Blanton M. Health service access, use, and insurance coverage among American Indians/Alaska Natives and Whites: what role does the Indian Health Service play? Am J Public Health. 2004;94:53–59.[Abstract/Free Full Text]

31. Baxter JD. Clinical research in the Canadian North: an overview of a decade of participation in the McGill University Baffin Zone Project. Acta Otolaryngol. 1983; 95:615–619.[Medline]

32. Beery QC, Doyle WJ, Cantekin EI, Bluestone CD, Wiet RJ. Eustachian tube function in an American Indian population. Ann Otol Rhinol Laryngol Suppl. 1980; 89:28–33.

33. Wiet RJ. Patterns of ear disease in the southwestern American Indian. Arch Otolaryngol. 1979;105:381–385.[Abstract/Free Full Text]

34. Arkell SM, Lightman DA, Sommer A, Taylor HR, Korshin OM, Tielsch JM. The prevalence of glaucoma among Eskimos of northwest Alaska. Arch Ophthalmol. 1987;105:482–485.[Abstract/Free Full Text]

35. Alsbirk PH. Anatomical risk factors in primary angle-closure glaucoma. A ten year follow up survey based on limbal and axial anterior chamber depths in a high risk population. Int Ophthalmol. 1992;16:265–272.[CrossRef][Web of Science][Medline]

36. Young TK. Review of research on aboriginal populations in Canada: relevance to their health needs. BMJ. 2003;327:419–422.[Abstract/Free Full Text]

37. Rousseau P. Native-American elders. Health care status. Clin Geriatr Med. 1995;11:83–95.[Web of Science][Medline]

38. Rhoades ER. American Indians and Alaska Natives—overview of the population. Public Health Rep. 1996;111(Suppl 2):49–50.[Web of Science][Medline]

This article has been cited by other articles:

				N. Ikeda, C. J. L. Murray, and J. A. Salomon Tracking Population Health Based on Self-reported Impairments: Trends in the Prevalence of Hearing Loss in US Adults, 1976-2006 Am. J. Epidemiol., July 1, 2009; 170(1): 80 - 87. [Abstract] [Full Text] [PDF]

				D. J. Lee, B. L. Lam, S. Arora, K. L. Arheart, K. E. McCollister, D. D. Zheng, S. L. Christ, and E. P. Davila Reported Eye Care Utilization and Health Insurance Status Among US Adults Arch Ophthalmol, March 1, 2009; 127(3): 303 - 310. [Abstract] [Full Text] [PDF]

				E. J. Samelson, J. L. Kelsey, D. P. Kiel, A. M. Roman, L. A. Cupples, M. B. Freeman, R. N. Jones, M. T. Hannan, S. G. Leveille, M. M. Gagnon, et al. Issues in Conducting Epidemiologic Research Among Elders: Lessons From The MOBILIZE Boston Study Am. J. Epidemiol., December 15, 2008; 168(12): 1444 - 1451. [Abstract] [Full Text] [PDF]

				J. J. Kronenfeld Changing conceptions of health and life course concepts. Health (London) , October 1, 2006; 10(4): 501 - 517. [Abstract] [PDF]

This Article Abstract Full Text (PDF) All Versions of this Article: AJPH.2004.056671v1 95/11/1940    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (13) Citing Articles via Google Scholar Google Scholar Articles by Caban, A. J. Articles by Zheng, D. D. Search for Related Content PubMed PubMed Citation Articles by Caban, A. J. Articles by Zheng, D. D. Related Collections Other Chronic Disease Epidemiology Other Race/Ethnicity Surveillance Surveys