Modification of the Association between Visual Impairment and Mortality by Physical Activity: A Cohort Study among the Korean National Health Examinees
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Participants
2.2. Visual Impairment
2.3. Physical Activity
2.4. All-Cause and Cause-Specific Mortality
2.5. Assumed Causal Pathway and Adjusted Covariates
2.6. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Characteristics | No Visual Impairment (n = 359,523) | Mild Visual Impairment (n = 328) | Severe Visual Impairment (n = 133) | p-Value a |
---|---|---|---|---|
Sex | ||||
Men | 194,785 (54.2) | 197 (60.1) | 70 (52.6) | 0.10 |
Women | 164,738 (45.8) | 131 (39.9) | 63 (47.4) | |
Household income (deciles) | ||||
0–3 | 73,251 (20.4) | 80 (24.4) | 25 (18.8) | 0.41 |
4–7 | 115,402 (32.1) | 104 (31.7) | 46 (34.6) | |
8–10 | 170,870 (47.5) | 144 (43.9) | 62 (46.6) | |
Body mass index (kg/m2) | ||||
<18.5 | 7848 (2.2) | 19 (5.8) | 7 (5.3) | <0.01 |
18.5–22.9 | 125,809 (35.0) | 114 (34.8) | 48 (36.1) | |
23–24.9 | 100,866 (28.1) | 93 (28.4) | 32 (24.1) | |
≥25 | 124,894 (34.8) | 102 (31.1) | 46 (34.6) | |
Smoking status | ||||
Non-smoker | 227,957 (64.5) | 229 (70.0) | 89 (68.5) | 0.04 |
Ex-smoker | 65,591 (18.5) | 63 (19.3) | 21 (16.2) | |
Smoker | 60,142 (17.0) | 35 (10.7) | 20 (15.4) | |
Alcohol consumption | ||||
None | 215,080 (60.3) | 234 (71.6) | 99 (74.4) | <0.01 |
1–2 times/week | 91,879 (25.7) | 47 (14.4) | 20 (15.0) | |
3–4 times/week | 32,086 (9.0) | 21 (6.4) | 8 (6.0) | |
≥5 times/week | 17,876 (5.0) | 25 (7.7) | 6 (4.5) | |
Physical activity | ||||
None | 211,833 (59.3) | 258 (79.1) | 101 (76.5) | <0.01 |
1–2 times/week | 78,179 (21.9) | 36 (11.0) | 20 (15.2) | |
3–4 times/week | 39,323 (11.0) | 7 (2.2) | 3 (2.3) | |
≥5 times/week | 28,044 (7.9) | 25 (7.7) | 8 (6.1) | |
History of stroke | ||||
No | 253,662 (98.2) | 251 (93.7) | 97 (93.3) | <0.01 |
Yes | 4638 (1.8) | 17 (6.3) | 7 (6.7) | |
History of heart disease | ||||
No | 246,268 (95.3) | 246 (92.1) | 94 (90.4) | <0.01 |
Yes | 12,137 (4.7) | 21 (7.9) | 10 (9.6) | |
History of hypertension | ||||
No | 164,856 (63.5) | 133 (49.4) | 49 (46.7) | <0.01 |
Yes | 94,633 (36.5) | 136 (50.6) | 56 (53.3) | |
History of type 2 diabetes | ||||
No | 227,279 (87.9) | 212 (79.1) | 82 (78.1) | <0.01 |
Yes | 31,401 (12.1) | 56 (20.9) | 23 (21.9) | |
History of dyslipidemia | ||||
No | 242,507 (93.8) | 251 (94.0) | 98 (92.5) | 0.84 |
Yes | 16,087 (6.2) | 16 (6.0) | 8 (7.6) | |
History of other diseases including cancer | ||||
No | 229,876 (88.9) | 219 (82.0) | 88 (84.6) | <0.01 |
Yes | 28,576 (11.1) | 48 (18.0) | 16 (15.4) | |
Age (years) | 59.0 ± 8.8 | 72.5 ± 8.8 | 68.9 ± 9.2 | <0.01 |
Waist circumference (cm) | 82.0 ± 8.2 | 83.0 ± 8.9 | 82.9 ± 8.5 | 0.05 |
Systolic blood pressure (mmHg) | 125.3 ± 15.2 | 130.5 ± 16.3 | 129.1 ± 16.3 | <0.01 |
Diastolic blood pressure (mmHg) | 77.6 ± 9.9 | 78.6 ± 9.9 | 77.9 ± 10.8 | 0.18 |
Fasting serum glucose level (mg/dL) | 101.2 ± 25.3 | 106.7 ± 32.1 | 104.4 ± 26.2 | <0.01 |
Serum creatinine level (mg/dL) | 1.1 ± 1.2 | 1.1 ± 1.0 | 1.0 ± 1.0 | 0.94 |
AST level (U/L) | 26.5 ± 18.4 | 25.9 ± 10.0 | 27.4 ± 14.3 | 0.71 |
ALT level (U/L) | 25.1 ± 19.1 | 21.9 ± 12.1 | 23.2 ± 15.6 | <0.01 |
γ-GT level (U/L) | 38.2 ± 53.6 | 30.9 ± 23.8 | 36.1 ± 36.6 | 0.04 |
Visual Function | No. of Deaths | HR | 95% CI | p-Value for Trend |
---|---|---|---|---|
Analyses not adjusted for physical activity a | ||||
All-cause mortality | ||||
No visual impairment | 8211 | Ref. | Ref. | 0.03 |
Mild visual impairment | 34 | 1.17 | 0.81, 1.69 | |
Severe visual impairment | 16 | 1.90 | 1.08, 3.35 | |
Mortality due to cardiovascular diseases | ||||
No visual impairment | 1202 | Ref. | Ref. | 0.02 |
Mild visual impairment | 6 | 1.22 | 0.85, 1.76 | |
Severe visual impairment | 5 | 1.84 | 1.04, 3.23 | |
Mortality due to cancers | ||||
No visual impairment | 3415 | Ref. | Ref. | 0.34 |
Mild visual impairment | 9 | 0.83 | 0.39, 1.74 | |
Severe visual impairment | 2 | 0.44 | 0.06, 3.10 | |
Mortality due to other diseases | ||||
No visual impairment | 3504 | Ref. | Ref. | 0.01 |
Mild visual impairment | 19 | 1.60 | 1.00, 2.54 | |
Severe visual impairment | 9 | 2.20 | 0.99, 4.90 | |
Analyses further adjusted for physical activityb | ||||
All-cause mortality | ||||
No visual impairment | 8211 | Ref. | Ref. | 0.03 |
Mild visual impairment | 34 | 1.16 | 0.81, 1.67 | |
Severe visual impairment | 16 | 1.87 | 1.06, 3.29 | |
Mortality due to cardiovascular diseases | ||||
No visual impairment | 1202 | Ref. | Ref. | 0.03 |
Mild visual impairment | 6 | 1.21 | 0.84, 1.75 | |
Severe visual impairment | 5 | 1.80 | 1.02, 3.18 | |
Mortality due to cancers | ||||
No visual impairment | 3415 | Ref. | Ref. | 0.33 |
Mild visual impairment | 9 | 0.83 | 0.39, 1.74 | |
Severe visual impairment | 2 | 0.43 | 0.06, 3.07 | |
Mortality due to other diseases | ||||
No visual impairment | 3504 | Ref. | Ref. | 0.01 |
Mild visual impairment | 19 | 1.58 | 0.99, 2.51 | |
Severe visual impairment | 9 | 2.15 | 0.96, 4.79 |
Visual Function | No. of Death | HR | 95% CI | p-Value for Trend |
---|---|---|---|---|
Not engaging in physical activity (None) | ||||
No visual impairment | 5921 | Ref. | Ref. | 0.01 |
Mild visual impairment | 31 | 1.28 | 0.88, 1.86 | |
Severe visual impairment | 15 | 1.96 | 1.09, 3.55 | |
Engaging in physical activity (≥once/week) | ||||
No visual impairment | 2234 | Ref. | Ref. | 0.41 |
Mild visual impairment | 3 | 0.29 | 0.04, 2.09 | |
Severe visual impairment | 1 | 1.11 | 0.16, 7.88 |
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Kim, K.-N.; Park, S.J.; Kim, W.; Joo, J.; Kim, H.; Kim, K.H.; Sohn, J.H.; Kwon, Y.J. Modification of the Association between Visual Impairment and Mortality by Physical Activity: A Cohort Study among the Korean National Health Examinees. Int. J. Environ. Res. Public Health 2019, 16, 4386. https://doi.org/10.3390/ijerph16224386
Kim K-N, Park SJ, Kim W, Joo J, Kim H, Kim KH, Sohn JH, Kwon YJ. Modification of the Association between Visual Impairment and Mortality by Physical Activity: A Cohort Study among the Korean National Health Examinees. International Journal of Environmental Research and Public Health. 2019; 16(22):4386. https://doi.org/10.3390/ijerph16224386
Chicago/Turabian StyleKim, Kyoung-Nam, Sang Jun Park, Woosung Kim, Jungmin Joo, Haebin Kim, Kyae Hyung Kim, Ji Hoon Sohn, and Yong Jin Kwon. 2019. "Modification of the Association between Visual Impairment and Mortality by Physical Activity: A Cohort Study among the Korean National Health Examinees" International Journal of Environmental Research and Public Health 16, no. 22: 4386. https://doi.org/10.3390/ijerph16224386