Background:Visual impairment is linked to a broad spectrum of health conditions. Nevertheless, there is an absence of large cohort studies investigating cancer risk in the visually impaired compared to seeing controls. The aim of this study was to investigate whether visually impaired adults have an increased risk for various types of cancer, compared to seeing controls.Methods:This was a retrospective cohort study comparing visually impaired adults aged 40 and over and 1:5 matched controls (by sex, birth year, and county of residence), between 2002 and 2018. Data were extracted from the Swedish National patient Registry, Statistics Sweden and from the Swedish Cause of Death Registry. A total of 48,493 adult Swedish men (44%) and women (56%), with a median age of 77 years (IQR: 64–86), with various degrees of visual impairment, from mild to total blindness, and 242,465 matched controls were followed up for a median of 5.1 (IQR 2.9–8.6) and 6.0 (IQR 3.6–9.8) years, respectively. The main outcomes included overall cancer incidence and incidence of different types of cancer.Results:Data analysis showed that visually impaired adults had an 18% significantly increased risk of any cancer (HR 1.18, 95% CI 1.16–1.20) when compared to seeing controls. The risk was also significantly increased for most cancers, with HRs ranging from 2.59 (95% CI 2.21–3.03) for brain cancer to 1.19 (95% CI 1.11–1.27) for breast cancer. No interaction was observed between cancer of any type and sex (p= 0.47). An elevated risk for all cancers in the visually impaired was observed across all age-groups: HR of 1.37 (95% CI 1.30–1.43) for ages 40–64, HR 1.17 (95% CI 1.13–1.20) for ages 65–79, and HR 1.11 (95% CI 1.08–1.15) for ages over 80. The risk of death was 60% higher among the cases compared to controls (HR 1.60, 95% CI 1.58–1.63).Conclusions:In this retrospective study of older adults, visual impairment was associated with increased cancer risk both overall and for specific types of cancer, in both sexes and across different age divisions of the cohort. These findings indicate the need for adjustments in health care polices in order to ensure equity in medical services.
背景：视力障碍与多种健康状况相关。然而，目前缺乏大规模队列研究比较视力障碍者与视力正常对照组的癌症风险。本研究旨在探讨与视力正常对照组相比，视力障碍成年人是否具有更高的各类癌症风险。 方法：本研究为回顾性队列研究，比较了2002年至2018年间40岁及以上视力障碍成年人及其1:5匹配对照组（按性别、出生年份和居住县匹配）。数据来源于瑞典国家患者登记系统、瑞典统计局及瑞典死因登记系统。共纳入48,493名瑞典成年男性（44%）和女性（56%），中位年龄77岁（四分位距：64-86岁），其视力障碍程度从轻度至完全失明不等，同时纳入242,465名匹配对照。中位随访时间分别为5.1年（四分位距2.9-8.6年）和6.0年（四分位距3.6-9.8年）。主要结局指标包括总体癌症发病率及不同类型癌症的发病率。 结果：数据分析显示，与视力正常对照组相比，视力障碍成年人的总体癌症风险显著增加18%（风险比1.18，95%置信区间1.16-1.20）。大多数癌症风险均显著升高，风险比范围从脑癌的2.59（95%置信区间2.21-3.03）到乳腺癌的1.19（95%置信区间1.11-1.27）。未观察到任何类型癌症与性别之间存在交互作用（p=0.47）。在所有年龄组中均观察到视力障碍者癌症风险升高：40-64岁组风险比1.37（95%置信区间1.30-1.43），65-79岁组1.17（95%置信区间1.13-1.20），80岁以上组1.11（95%置信区间1.08-1.15）。病例组的死亡风险较对照组高60%（风险比1.60，95%置信区间1.58-1.63）。 结论：在这项针对老年人的回顾性研究中，视力障碍与总体癌症风险及特定类型癌症风险增加相关，这种关联在两种性别及不同年龄分层中均存在。这些发现提示需要调整医疗保健政策，以确保医疗服务的公平性。
Visual Impairment and Cancer Risk: A Nationwide Cohort Study of Adult Swedish Men and Women
肿瘤(癌症)患者之家