The Association Between Sensory Impairments And The Risk Of Mortality: A Meta-analysis

Objective: The findings from prospective studies on visual impairment(VI)or hearing impairment(HI)and the risk of mortality are not consistent.A meta-analysis was conducted to quantitatively summarize the evidence about the association between VI or HI and the risk of mortality.Methods: Pertinent studies were identified by a search of Pub Med,Web of Science,Chinese National Knowledge Infrastructure and Wanfang databases up to May 2016.Furthermore,the reference lists of retrieved articles were reviewed for undetected relevant studies.I~2 was used to assess heterogeneity among studies.The Der Simonian and Laird random effects model(REM)was selected as the pooling method if substantial heterogeneity was present(I~2>50%);otherwise,the fixed effects model(FEM)was adopted.Meta-regression with restricted maximum likelihood estimation was conducted to explore potential sources of heterogeneity.A sensitive analysis was performed with one study removed at a time to assess whether the results could have been affected markedly by a single study.Publication bias was evaluated with visual inspection of the funnel plot and Egger's test.For dose–response relationship,a two-stage random-effect dose–response meta-analysis was performed to compute the trend from the correlated log relative risk estimates across level of VA.Results: For highest VI level versus no VI,the pooled RR of overall data was 1.34(95%CI: 1.25,1.45,I~2 = 61.8%).In the subjects older than 65,the pooled RR was 1.27(95%CI: 1.17,1.37,I~2 = 54.6%).When men and women were analysed separately,the pooled RR of the risk of mortality was 1.29(95%CI: 1.07,1.54,I~2 =60.4%)in men and 1.39(95%CI: 1.14,1.70,I~2 = 74.0%)in women.subgroup analyses were performed by continent,VI assessment and follow-up duration,and all subgroup analysis manifested that VI was associated with a statistically significant increased risk of mortality.A linear relation was found between VA and the risk of mortality(Pnonlinearity=0.38)The dose–response analysis suggested that the risk of mortality increased by 4%(RR: 1.04,95%CI: 1.01,1.06)for 0.1 Log MAR increment of VA.The Egger's test and funnel plot detected no evidence of significant publication bias.For the highest HI level versus no HI,the pooled RR was 1.10(95%CI: 1.04,1.16,I~2=20.1%).Subgroup analyses were performed by continent,follow-up duration,HI assessment and whether adjusted for age.The findings showed a significant association in North America(RR=1.09,95%CI 1.01 to 1.18),Europe(RR=1.17,95%CI 1.03 to 1.32),audiometry assessment(RR=1.18,95%CI 1.08 to 1.28),studies of follow-up duration longer than 6 years(RR=1.11,95%CI 1.03 to 1.19)and adjusted for age(RR=1.12,95%CI 1.05 to 1.19).The Egger's test and funnel plot detected no evidence of significant publication bias.Conclusion: VI or HI was significantly associated with an increased risk of mortality.