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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
  • 15,430 View
  • 146 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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.

Citations

Citations to this article as recorded by  
  • Exploring association between ambient air pollution and glaucoma in China: a nationwide analysis with predictive modeling based on the China Health and Retirement Longitudinal Study
    Xiang Li, Zhan-Yang Luo, Sen Lei, Zhi-Jie Zhang, Jia-feng Tang, Yi-qing Sun
    Frontiers in Public Health.2025;[Epub]     CrossRef
  • Estimated glucose disposal rate and its dual role in hyperlipidemia risk and mortality: a secondary analysis of retrospective cohort data from U.S. and Chinese
    Shouxin Wei, Sijia Yu, Chuan Qian, Zhengwen Xu, Yindong Jia, Bo Chen
    Lipids in Health and Disease.2025;[Epub]     CrossRef
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
  • 14,208 View
  • 179 Download
  • 5 Web of Science
  • 7 Crossref
AbstractAbstract AbstractSummary 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.

Citations

Citations to this article as recorded by  
  • Global Burden and Trends of Glaucoma in Adults Aged 55 and Older, 1990 to 2021: An Analysis of the Global Burden of Disease Study
    Liu Yuxi, Huo Ye, Liu Jingyuan, Xu Kejia, Luo Shasha, Chen Jiawei
    Ophthalmic Epidemiology.2026; : 1.     CrossRef
  • Evaluating the impact of caloric restriction, body mass index and exercise on primary open-angle glaucoma: A review
    Jonathan YM Lai, Patrick Mclarnon, Carl Sheridan, Neeru A Vallabh
    European Journal of Ophthalmology.2025; 35(2): 429.     CrossRef
  • Obesity and its management in primary care setting
    Mahmoud Ibrahim, Ebtesam M. Ba-Essa, Jessica A. Alvarez, Jason Baker, Vincenzo Bruni, Avivit Cahn, Antonio Ceriello, Francesco Cosentino, Melanie J. Davies, Francesco De Domenico, Robert H. Eckel, Allon N. Friedman, Jonathan Goldney, Omer Hamtzany, Scott
    Journal of Diabetes and its Complications.2025; 39(7): 109045.     CrossRef
  • Identifying Modifiable Risk Factors for Glaucoma
    Pooja Bhardwaj, Swati Shukla, Sana Nafees, Km Ambika, Dewang Angmo, Jasbir Kaur
    Journal of Current Ophthalmology.2025; 37(1): 1.     CrossRef
  • Assessment of choroidal structures in morbidly obese women
    Mustafa Berhuni, Mehmet Sait Berhuni, Tahsin Özenmiş, Özen Atalay Özmen
    Spektrum der Augenheilkunde.2025; 39(6): 193.     CrossRef
  • The relationship between weight-adjusted-waist index, body mass index and diabetic retinopathy among American adults: a population-based analysis
    Songtao Wang, Hecong Qin, Yu Zhang, Ning Yang, Jinsong Zhao
    Scientific Reports.2024;[Epub]     CrossRef
  • The Weight on Sight: Exploring the Links Between Obesity and Ocular Diseases
    Ahmed Bilal, Muslim Bilal, Alia Hathaf, Danyal Usman, Nadim Haboubi
    Cureus.2024;[Epub]     CrossRef
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