Epidemiology and Health

Original Articles

Decomposition of socioeconomic inequalities in glaucoma knowledge in Taiwan: Chiun-Ho Hou, Christy Pu; Epidemiol Health. 2024;46:e2024004. Published online December 5, 2023; DOI: https://doi.org/10.4178/epih.e2024004

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Abstract Summary PDF: Abstract
OBJECTIVES
Glaucoma knowledge is strongly associated with medication adherence and preventive behavior. Studies have frequently reported socioeconomic inequalities in glaucoma knowledge. This study aimed to decompose such inequalities. Decomposition analysis enables the design of policies directly targeting the underlying causes of inequality.
METHODS
We performed a cross-sectional survey from January 1, 2019 to June 30, 2019, at the departments of ophthalmology of 2 medical centers belonging to a hospital chain in northern Taiwan. Socioeconomic inequalities in glaucoma knowledge were ranked based on 3 aspects of socioeconomic status (SES): (1) education, (2) income, and (3) self-perceived financial status. The concentration index was calculated and decomposed using decomposition analysis. Elasticity and marginal effects were estimated for each decomposed factor.
RESULTS
In total, 1,203 patients completed the survey. Both measures of glaucoma knowledge and overall glaucoma knowledge score significantly contributed to the progressivity of knowledge inequalities (pro-high-SES inequalities). The concentration index for overall knowledge score with respect to education was 0.166 (p<0.001). Both objective and subjective measures of SES were associated with pro-high-SES inequalities. Our decomposition analysis revealed that demographic factors and attitudinal factors such as the level of concern regarding developing glaucoma contributed significantly to SES-based inequalities in glaucoma knowledge.
CONCLUSIONS
Our decomposition analysis provided empirical evidence regarding the underlying causes of SES-based inequalities in glaucoma knowledge. Efforts to improve glaucoma knowledge should consider specific factors that drive SES-based inequalities, such as age, sex, and concern about vision health, to ultimately achieve low SES-based inequalities.; Summary

Key Message
This study investigates the relationship between glaucoma knowledge and socioeconomic status (SES) inequalities, and the underlying causes of these disparities. The study concludes that understanding the drivers of SES-based inequalities in glaucoma knowledge, like age, gender, and concerns about vision health, is crucial. This understanding can guide efforts to improve glaucoma awareness and address SES-based disparities in knowledge, aiming to reduce these inequalities.

The association between glaucoma and all-cause mortality in middle-aged and elderly Chinese people: results from the China Health and Retirement Longitudinal Study: Xiaoxu Huang, Mengqiao Xu, Minwen Zhou, Wenjia Liu, Xiaohuan Zhao, Xiaodong Sun; Epidemiol Health. 2023;45:e2023066. Published online July 21, 2023; DOI: https://doi.org/10.4178/epih.e2023066

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This population-based, prospective cohort study investigated the association between glaucoma and mortality in older adults.
METHODS
Participants aged 45 years or older at baseline (47.9% male) were enrolled in 2011 for the China Health and Retirement Longitudinal Study (CHARLS). All-cause mortality was observed during 7 years of follow-up. The baseline data were collected in the 2011 CHARLS, and participants were followed up for 7 years (until 2018). The risk of all-cause mortality was investigated using Cox proportional-hazards regression with age as the time scale, adjusting for significant risk factors and comorbid conditions.
RESULTS
Among the 14,803 participants included, the risk of all-cause death was significantly higher among people with glaucoma than among those without glaucoma, after adjustment for other confounders (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.04 to 2.03). In a subgroup analysis based on the mean age of death, among those who were 75 years and older (n=1,231), the risk of all-cause death was significantly higher in patients with glaucoma than in those without glaucoma (HR, 1.89; 95% CI, 1.24 to 1.89).
CONCLUSIONS
Participants with glaucoma had a higher risk of all-cause mortality, especially those aged 75 years and above. Our findings revealed potential mechanisms underlying an association between glaucoma and all-cause mortality. They also highlighted the importance of glaucoma management to prevent premature death in middle-aged and older adults.; Summary

Key Message
The present study suggests that glaucoma is associated with a higher rate of mortality in middle-aged and elderly people in China, especially for those aged 75 years and older. This study provides an important reference for the design and evaluation of clinical glaucoma treatment and the management of patients of different ages.

The association between obesity and glaucoma in older adults: evidence from the China Health and Retirement Longitudinal Study: Xiaohuan Zhao, Qiyu Bo, Junran Sun, Jieqiong Chen, Tong Li, Xiaoxu Huang, Minwen Zhou, Jing Wang, Wenjia Liu, Xiaodong Sun; Epidemiol Health. 2023;45:e2023034. Published online March 9, 2023; DOI: https://doi.org/10.4178/epih.e2023034

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Abstract Summary PDF: Abstract
OBJECTIVES
This study evaluated the association between obesity and glaucoma in middle-aged and older people. A population-based retrospective cohort study was conducted using data from the China Health and Retirement Longitudinal Study.
METHODS
Glaucoma was assessed via self-reports. Multivariate logistic regression analysis and a Cox proportional hazards model were used to assess the relationship between obesity and glaucoma risk.
RESULTS
Older males living in urban areas who were single, smokers, and non-drinkers were found to have a significantly higher incidence of glaucoma (all p<0.05). Diabetes, hypertension, and kidney disease were also associated with higher glaucoma risk, while dyslipidemia was associated with lower risk (all p<0.05). After the model was adjusted for demographic, socioeconomic, and health-related variables, obesity was significantly associated with a 10.2% decrease in glaucoma risk according to the Cox proportional hazards model (hazard ratio, 0.90; 95% confidence interval [CI], 0.83 to 0.97) and an 11.8% risk reduction in the multivariate logistic regression analysis (odds ratio, 0.88; 95% CI, 0.80 to 0.97). A further subgroup analysis showed that obesity was associated with a reduced risk of glaucoma in people living in rural areas, in smokers, and in those with kidney disease (all p<0.05). Obesity also reduced glaucoma risk in people with diabetes, hypertension, or dyslipidemia more than in healthy controls (all p<0.05).
CONCLUSIONS
This cohort study suggests that obesity was associated with a reduced risk of glaucoma, especially in rural residents, smokers, and people with kidney disease. Obesity exerted a stronger protective effect in people with diabetes, hypertension, or dyslipidemia than in healthy people.; Summary

Key Message
Glaucoma is a neurodegenerative disease and the leading cause of irreversible vision loss worldwide. The diagnosis of glaucoma is frequently delayed, as it may be asymptomatic until a relatively late stage. Thus, there is a need to identify protective and risk factors for glaucoma. Glaucoma is a multifactorial disease, and the impact of obesity on glaucoma risk remains uncertain. This study evaluated the association between obesity and glaucoma in middle-aged and older people. This cohort study suggests that obesity was associated with a reduced risk of glaucoma, especially in rural residents, smokers, and people with kidney disease.

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