Millions of Americans have severe visual impairment or are blind. As rates continue to climb with the aging of the population, inpatient providers will encounter more patients with this disability and they will be expected to effectively manage this vulnerable population. This study shows that compared to those who are not visually impaired, patients with SVI/B who are hospitalized have higher mortality rates, longer LOS, and are less likely to be discharged to home following the admission. Moreover, among patients with SVI/B, those who were obese had higher total hospital charges than their non-obese counterparts.
A 2013 study from Western Australia discovered that legally blind hospitalized adults had a seven times higher mortality rate compared to patients with normal vision (8). This was carried out using a regional registry; the analysis reviewed over 12,000 hospitalizations of blind adults between study years 1999 and 2010. In a longitudinal study from 2002–2013 using the Korean National Health Insurance database, Choi also found that those with blindness (> 1200 individuals) also had a higher mortality than patients with normal sight (9). This association held in distinct analyses assessing both older (> 60 years of age) and younger (< 60 years) patients (9). In 2013, the World Health Organization (WHO) launched a global action plan for universal eye health with specific guidance for caring for those with SVI/B (10). These efforts were intended to heighten awareness and escalate the reporting of vision loss in hopes of modifying clinical practice. The current study provides more recent results compared to those from Australia and Korea, while substantiating their findings within a larger cohort. Further, the associations noted among patients hospitalized in the US illustrate that the WHO’s concerns about worse healthcare outcomes among those who are blind are still justified.
To explore in-hospital resource utilization, Morse studied two claims databases - Medicare database and Clinformatics DataMart; their objective was to compare the care of older hospitalized patients with and without vision loss (6). The study found that patients with severe vision loss had longer LOS, more readmissions, and higher hospital costs compared to patients without vision loss. Though our study also found that patients with SVI/B had longer LOS, there were not significantly higher hospital charges compared to those without this disability. The differences in the results might be explained by the fact that our patient population was broader, including younger hospitalized adults. Also, if the longer LOS was attributable to time spent on education and coordination of care, the lack of variance in charges accrued over the protracted time span may be linked to Taheri’s observations that LOS attributable to the last portion of the hospitalization does not significantly contribute to hospital costs (11). For these very reasons, LOS is not always correlated with hospital costs (12). Given that a significantly higher number of SVI/B patients were discharge to facilities rather than to their homes, it may be reasonable to presume that they did not amass high charges while awaiting placement. By contrast, the cohort of hospitalized SVI/B patients who were obese had significantly higher average charges; this result is similar to other studies that have examined the impact of obesity among those who are hospitalized (13). Future studies may need to target vision information at the time of hospitalization to determine if this would alter the hospitalization or decrease morbidity and mortality.
Several limitations of this study should be considered. First, the NIS is an administrative database wherein data is highly dependent on coding imputations. It is possible that under-coding for SVI/B and obesity may have occurred. Second, the NIS lacks detailed lab data or imaging results, and medications cannot be examined. Thus, an in-depth investigation into the details of our findings was not feasible. Third, special circumstances that might have influenced diagnostic or treatment decisions, such as social factors and patients’ preferences, cannot be determined from administrative databases. Lastly, in observational studies there may be unmeasured and unknown confounders that influence outcomes. Observed associations suggest relationships between variables but do not prove causality.