Original Article
Risk of type 2 diabetes mellitus among adults aging with vision impairment: The role of the neighborhood environment

https://doi.org/10.1016/j.dhjo.2022.101371Get rights and content

Abstract

Background

Vision impairment (VI) affects approximately 1 in 28 Americans over the age of 40 and the prevalence increases sharply with age. However, experiencing vision loss with aging can be very different from aging with VI acquired earlier in life. People aging with VI may be at increased risk for diabetes due to environmental barriers in accessing health care, healthy food, and recreational resources that can facilitate positive health behaviors.

Objective

This study examined the relationship between neighborhood characteristics and incident type 2 diabetes mellitus (T2DM) among a cohort of 22,719 adults aging with VI.

Methods

Data are from Optum® Clinformatics® DataMart, a private administrative claims database (2008–2017). Individuals 18 years of age and older at the time of their initial VI diagnosis were eligible for analysis. VI was determined using vision impairment, low vision, and blindness codes (ICD-9-CM, ICD-10-CM). Covariates included age, sex, and comorbidities. Cox models estimated adjusted hazard ratios (HRs) for incident T2DM. Stratified models examined differences in those aging with (age 18–64) and aging into (age 65+) vision impairment.

Results

Residence in neighborhoods with greater intersection density (HR = 1.26) and high-speed roads (HR = 1.22) were associated with increased risk of T2DM among older adults with VI. Living in neighborhoods with broadband internet access (HR = 0.67), optical stores (HR = 0.62), supermarkets (HR = 0.78), and gyms/fitness centers (HR = 0.63) was associated with reduced risk of T2DM for both younger and older adults with VI.

Conclusions

Findings emphasize the importance of neighborhood context for mitigating the adverse consequences of vision loss for health.

Section snippets

Data source

The data source for this research was a private payer administrative claims database, Optum® Clinformatics® DataMart (hereafter called Optum). Optum is a de-identified administrative claims database of more than 80 million individuals in the U.S. Enrolled beneficiaries' service utilization includes emergency department, outpatient, and inpatient encounters. All enrollees in the database had evidence of enrollment on the insurance plan between 2001 and 2019. Because of our interest in

Results

Table 1 describes the demographic and clinical characteristics of the study cohort overall and stratified by age. On average, the cohort was 68.2 years of age. The majority (69.1%) was age 65 or older, while 30.9% were age 18–64 years. Roughly half of the cohort was female (56.4% overall). On average, individuals had an Elixhauser Comorbidity Index score of 0.8, indicating the presence of about 1 comorbid chronic health condition at the time of entry to the cohort. Of the 22,719 adults with VI,

Discussion

Using prospective data from a large nationwide cohort in a private payer administrative claims database, we examined how features in the local residential environment were related to incident T2DM among both younger and older adults with VI. We found that one in seven adults with VI developed T2DM over the 3+ year follow up, highlighting the adverse impact of VI on health disorders.10 We hypothesized that residence in neighborhoods with more health care resources, fewer traffic risks, and with

Funding

This work was funded by a grant from the Michigan Center for Clinical and health Research (MICHR) supported by the National Institutes of Health (NIH; U-M MICHR Accelerating Synergy Award UL1TR002240: “Health and Healthcare Disparities Among Adults Aging with Disabilities”). JRE is supported by a grant from the National Institutes of Health (K23EY027848) and PC, MDP and MAM are supported by a grant from the National Institute of Disability, Independent Living and Rehabilitation Research (

Conflicts of interest

NK N.K. maintains financial interest and consults for Lucent Surgical. No other author has a conflict of interest to declare.

References (40)

  • H. Chaudhury et al.

    Neighbourhood environment and physical activity in older adults

    Soc Sci Med

    (2016)
  • S.M. Mah et al.

    Does living near hospital obscure the association between active living environments and hospitalization?

    Health Place

    (2022)
  • E. Buajitti et al.

    Agreement between area-and individual-level income measures in a population-based cohort: implications for population health research

    SSM-Population Health

    (2020)
  • R. Varma et al.

    Visual impairment and blindness in adults in the United States: demographic and geographic variations from 2015 to 2050

    JAMA Ophthalmol

    (2016)
  • A.D. Flaxman et al.

    Prevalence of visual acuity loss or blindness in the US: a Bayesian meta-analysis

    JAMA Ophthalmol

    (2021)
  • C.E. Sherrod et al.

    Association of vision loss and work status in the United States

    JAMA Ophthalmol

    (2014)
  • L. Assi et al.

    Association of vision impairment with preventive care use among older adults in the United States

    JAMA Ophthalmol

    (2020)
  • H.-W. Wahl et al.

    Age-related macular degeneration and change in psychological control: role of time since diagnosis and functional ability

    J Gerontol B Psychol Sci Soc Sci

    (2007)
  • H.-W. Wahl et al.

    Psychosocial consequences of age-related visual impairment: comparison with mobility-impaired older adults and long-term outcome

    J Gerontol B Psychol Sci Soc Sci

    (1999)
  • J.B. Saaddine et al.

    Projection of diabetic retinopathy and other major eye diseases among people with diabetes mellitus: United States, 2005-2050

    Arch Ophthalmol

    (2008)

    • Cited by (0)

    View full text
    © 2022 Elsevier Inc. All rights reserved.