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Tseng VL, Chlebowski RT, Yu F, et al. Association of Cataract Surgery With Mortality in Older Women: Findings from the Women’s Health Initiative. JAMA Ophthalmol. 2018;136(1):3–10. doi:10.1001/jamaophthalmol.2017.4512
How is cataract surgery associated with mortality outcomes in women with cataract?
In this prospective cohort study of 74 044 participants of the Women's Health Initiative with cataract, cataract surgery was associated with increased risk for all-cause mortality and mortality attributed to vascular, cancer-related, accidental, pulmonary, and infectious causes, even after adjusting for demographics and systemic and ocular comorbidities.
In women with cataract, cataract surgery may be associated with higher mortality risk related to multiple types of systemic illness. However, this study cannot determine whether death events are attributable to the surgery itself, a result of surgery postponement, or other factors.
Previous studies have suggested an association between cataract surgery and decreased risk for all-cause mortality potentially through a mechanism of improved health status and functional independence, but the association between cataract surgery and cause-specific mortality has not been previously studied and is not well understood.
To examine the association between cataract surgery and total and cause-specific mortality in older women with cataract.
Design, Setting, and Participants
This prospective cohort study included nationwide data collected from the Women’s Health Initiative (WHI) clinical trial and observational study linked with the Medicare claims database. Participants in the present study were 65 years or older with a diagnosis of cataract in the linked Medicare claims database. The WHI data were collected from January 1, 1993, through December 31, 2015. Data were analyzed for the present study from July 1, 2014, through September 1, 2017.
Cataract surgery as determined by Medicare claims codes.
Main Outcomes and Measures
The outcomes of interest included all-cause mortality and mortality attributed to vascular, cancer, accidental, neurologic, pulmonary, and infectious causes. Mortality rates were compared by cataract surgery status using the log-rank test and Cox regression models with time-varying covariate cataract surgery status adjusting for demographics, systemic and ocular comorbidities, smoking, alcohol use, body mass index, and physical activity.
A total of 74 044 women with cataract in the WHI included 41 735 who underwent cataract surgery. Mean (SD) age was 70.5 (4.6) years; the most common ethnicity was white (64 430 [87.0%]), followed by black (5293 [7.1%]) and Hispanic (1723 [2.3%]). The mortality rate was 2.56 per 100 person-years in the cataract surgery group and 1.45 per 100 person-years in the cataract diagnosis group. In covariate-adjusted Cox models, cataract surgery was associated with higher all-cause mortality (adjusted hazards ratio [AHR], 1.07; 95% CI, 1.02-1.11) as well as higher mortality specific to vascular (AHR, 1.36; 95% CI, 1.26-1.46), cancer (AHR, 1.27; 95% CI, 1.18-1.38), accidental (AHR, 1.36; 95% CI, 1.05-1.76), pulmonary (AHR, 1.96; 95% CI, 1.62-2.37), and infectious (AHR, 1.37; 95% CI, 1.14-1.65) diseases. Neurologic death causes were not associated with cataract surgery (AHR, 0.98; 95% CI, 0.83-1.17)
Conclusions and Relevance
In older women with cataract in the WHI, cataract surgery was associated with higher risk for total and cause-specific mortality (except for neurologic causes). Further study of the interplay of cataract surgery, systemic disease, disease-related mortality, and the best timing of when to undergo cataract surgery would be informative for improved patient care.
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