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Articles by P Mitchell
Total Records ( 2 ) for P Mitchell
  M. J Karpa , P Mitchell , K Beath , E Rochtchina , R. G Cumming and J. J. Wang

Objective  To investigate pathways from visual impairment to increased all-cause mortality in older persons.

Methods  The Blue Mountains Eye Study examined 3654 persons 49 years and older (82.4% response) during 1992-1994 and after 5 and 10 years. Australian National Death Index data confirmed deaths until 2005. Visual impairment was defined as presenting, correctable, and noncorrectable, using better-eye visual acuity. Associations between visual impairment and mortality risk were estimated using Cox regression and structural equation modeling.

Results  After 13 years, 1273 participants had died. Adjusting for mortality risk markers, higher mortality was associated with noncorrectable visual impairment (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.04-1.75). This association was stronger for ages younger than 75 years (HR, 2.58; 95% CI, 1.42-4.69). Structural equation modeling revealed greater effects of noncorrectable visual impairment on mortality risk (HR, 5.25; 95% CI, 1.97-14.01 for baseline ages <75 years), with both direct (HR, 2.16; 95% CI, 1.11-4.23) and indirect (HR, 2.43; 95% CI, 1.17-5.03) effects. Of mortality risk markers examined, only disability in walking demonstrated a significant indirect pathway for the link between visual impairment and mortality.

Conclusions  Visual impairment predicted mortality by both direct and indirect pathways, particularly for persons younger than 75 years with noncorrectable visual impairment. Disability in walking, which can substantially influence general health, represented a major indirect pathway.

  V. S. E Jeganathan , N Cheung , W. T Tay , J. J Wang , P Mitchell and T. Y. Wong

Objective  To describe the prevalence and risk factors of retinopathy in an Asian population without diabetes.

Methods  We conducted a population-based, cross-sectional study of 3280 Malays aged 40 to 80 years residing in Singapore. Participants had retinal photographs taken, which were graded for retinopathy signs using the modified Airlie House Classification System. Risk factors were assessed from standardized interviews, clinical examinations, and laboratory investigations.

Results  Of participants without diabetes (n = 2500), 149 (6.0%; 95% confidence interval [CI], 5.0-6.9) had signs of retinopathy that represented minimal (5.8%) or mild (0.2%) retinopathy. After adjusting for multiple covariables, higher serum glucose levels (odds ratio [OR], 1.13; 95% CI, 1.00-1.28; per millimole per liter increase), higher systolic blood pressure (OR, 1.15; 95% CI, 1.06-1.25; per 10–mm Hg increase), higher body mass index (OR, 1.04; 95% CI, 1.00-1.07 per point increase), and a history of heart attack (OR, 2.68; 95% CI, 1.48-4.83) were significantly associated with the presence of retinopathy lesions in persons without diabetes.

Conclusions  Similar to studies in white individuals, signs of retinopathy are common in Asian persons without diabetes. Early signs of retinopathy in persons without diabetes are related to metabolic and vascular risk factors and may indicate intermediate pathologic changes along the pathway to cardiovascular disease.

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