ArticleBMJ open ophthalmology2026
Subjective and objective visual impairment and all-cause mortality in older US adults: the role of physical activity and depressive symptoms in NHANES 2007-2008.
Article in BMJ open ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo investigate the association between visual impairment (VI) and all-cause mortality in older US adults and to examine the potential mediating roles of physical activity (PA) and depressive symptoms. MATERIALS AND ANALYSIS: This prospective cohort study included adults aged 60 years and older from the 2007 to 2008 National Health and Nutrition Examination Survey. VI was defined as either subjective visual impairment (SVI) based on self-reported vision status or objective visual impairment (OVI) defined as presenting visual acuity worse than 20/40 in the better-seeing eye. Cox proportional hazards models adjusted for demographic, anthropometric, socioeconomic and clinical covariates were used to examine the association between VI and all-cause mortality with propensity score matching and subgroup analyses. PA was assessed using a modified International Physical Activity Questionnaire and depressive symptoms were assessed using the 9-item Patient Health Questionnaire. Mediation analyses were performed to estimate direct and indirect effects through PA and depressive symptoms.
resultsA total of 2154 participants (mean (SD) age 70.6 (7.1) years; 44.2% male) were included. Over a median follow-up of 145.0 months, 399 (57.8%) deaths occurred in the VI group and 535 (34.6%) in the non-VI group. VI was associated with an increased risk of all-cause mortality after propensity score matching and multivariable adjustment (HR, 1.21; 95% CI 1.04 to 1.41; p=0.012). In subgroup analyses, SVI was significantly associated with mortality (HR, 1.33; 95% CI 1.13 to 1.57; p=0.001), whereas OVI was not. PA mediated 9.4% of the association between VI and all-cause mortality, whereas depressive symptoms did not.
conclusionIn this nationally representative cohort, VI was independently associated with higher all-cause mortality in older US adults. SVI appeared more predictive than OVI, possibly reflecting broader functional vision burden. Reduced PA partially mediated this association, whereas depressive symptoms did not. Residual confounding and measurement error cannot be excluded.
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