Blindness, Cataract Surgery and Mortality in Ethiopia

Published in: British Journal of Ophthalmology, 2016

Posted on RAND.org on June 27, 2016

by Benjamin J. Thomas, David S. Sanders, Matthew S. Oliva, Mark S. Orrs, Peter Glick, Sanduk Ruit, Wei Chen, Jill E. Luoto, Alemu Kerie Tasfaw, Geoffrey C. Tabin

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Research Question

  1. What are the relationships between blindness, cataract surgery, and mortality in a rural Ethiopian population?

Purpose

To examine the relationships between blindness, the intervention of cataract surgery and all-cause mortality in a rural Ethiopian population.

Design

Population-based, interventional prospective study.

Methods

Community-based detection methods identified blind Ethiopian persons from two selected kebeles in Amhara region, Ethiopia. Data from 1201 blind patients were collected-628 cataract-blind and 573 blind from other conditions. Free cataract surgery was provided for consenting, cataract-blind patients. Follow-up surveys were conducted after 12 months (±1 month)-the main outcome measure for this report is all-cause mortality at 1 year.

Results

During the follow-up period, 110 persons died from the selected population (mortality 9.2%), which consisted of those cataract-blind patients who received cataract surgery (N=461), cataract-blind patients who did not receive surgery (N=167) and all non-cataract-blind patients (N=573). Of the 461 patients who received cataract surgery, 44 patients died (9.5%). Of the 740 patients who did not receive surgery, 66 died (8.9%)-28 patients from the cohort of cataract-blind patients who did not receive surgery (16.8%) and 38 patients from the cohort of non-cataract blind (6.6%). Subgroup analysis revealed significantly increased odds of mortality for cataract-blind patients over 75 years of age who did not receive surgery and for unmarried patients of all age groups.

Conclusions

In this population, mortality risk was significantly elevated for older cataract-blind patients when compared with non-cataract-blind patients-an elevation of risk that was not noted in an age-matched cohort of cataract-blind patients who underwent cataract surgery as early as 1-year follow-up.

Key Findings

  • Cataract patients who did not have surgery were the most likely to die within one year of any cohort in the study.
  • Cataract-blind patients over the age of 75 who received surgery were significantly less likely to die than their peers.
  • Risk of mortality was higher among unmarried subjects than married ones, suggesting that social isolation plays a role in mortality risk.
  • Neither gender nor presence of chronic disease seemed to affect mortality risk.

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