Prevalence and associated factors of osteoarthritis in the Ural Eye and Medical Study and the Ural Very Old Study.

To determine the prevalence of osteoarthritis and its associated factors in populations from Russia. The population-based Ural Eye and Medical Study (UEMS) and the population-based Ural Very Old Study (UVOS) were conducted in a rural and urban region in Bashkortostan/Russia and included participants aged 40+ and 85+ years, respectively. As part of a detailed systematic examination, we assessed the osteoarthritis prevalence in an interview including questions on the self-reported presence of osteoarthritis, the joints affected and osteoarthritis-related pain-relieving therapy taken. Out of 5898 participants of the UEMS, 1636 individuals had osteoarthritis [prevalence: 27.7%; 95% confidence interval (CI) 26.7, 28.7], with 816 individuals (13.8%; 95% CI 12.8, 14.8) taking pain-relieving medication. A higher osteoarthritis prevalence was associated (multivariable analysis) with older age [odds ratio (OR 1.04; 95% confidence interval (CI) 1.03, 1.05], urban region of residence (OR 1.25; 95% CI 1.07, 1.45), higher body mass index (BMI) (OR 1.04; 95% CI 1.03, 1.06), lower monthly income (OR 0.78; 95% CI 0.68, 0.90), higher physical activity score (OR 1.02, 95% CI 1.01, 1.03), higher prevalence of a history of cardiovascular disease including stroke (OR 1.55; 95% CI 1.33, 1.81), previous bone fractures (OR 1.20; 95% CI 1.04, 1.40) and previous falls (OR 1.22; 95% CI 1.03, 1.45), higher hearing loss score (OR 1.01; 95% CI 1.01, 1.02), and less alcohol consumption (OR 0.78; 95% CI 0.65, 0.93). Out of 1526 UVOS participants, 567 individuals had osteoarthritis (prevalence: 37.2%; 95% CI 35.0, 40.0), with 195 (12.8%; 95% CI 11.3, 14.3) individuals taking pain-relieving medication. Higher osteoarthritis prevalence was associated with rural region of habitation (OR 1.69; 95% CI 1.20, 2.38), lower monthly income (OR 0.62; 95% CI 0.46, 0.84), higher prevalence of cardiovascular disease (OR 1.75; 95% CI 1.30, 2.36), and higher anxiety score (OR 1.04; 95% CI 1.03, 1.06). Osteoarthritis and use of pain-relieving medication are common in these populations in Russia. Main associated factors were older age and lower monthly income in both study populations, female sex, higher BMI, urban region, and previous falls and bone fractures in the UEMS population, and rural region and a higher anxiety score in the UVOS study population.

Prevalence of metabolic syndrome in a Russian population: The Ural Eye and Medical Study and the Ural Very Old Study.

Purpose: To examine prevalence and associated factors of the metabolic syndrome (MS) in populations in Russia. Methods: Two population-based studies (Ural Eye and Medical Study (UEMS), Ural Very Old Study (UVOS)) were conducted in rural and urban regions in Bashkortostan/Russia and included participants aged 40+ years and 85+ years, respectively. Results: Out of 5895 UEMS participants, 1572 individuals had MS (prevalence:26.7%; 95% confidence interval (CI):25.5,27.8). The criteria of waist circumference, blood pressure, hyperglycemia, serum high-density lipoprotein concentration and serum triglyceride concentration were fulfilled by 4269 (72.4%; 95%CI:71.3,73.6), 3168 (53.7%; 95%CI:52.5,55.1), 1375 (23.3%; 95%CI:22.4,24.6), 712 (13.3%; 95%CI:12.4,14.2), and 1527 (28.6%; 95%CI:27.4,29.8) individuals, respectively. Higher MS prevalence was associated with older age (odds ratio (OR):1.03; 95%CI:1.02,1.04;P < 0.001), female sex (OR:1.93; 95%CI:1.51,2.47;P < 0.001), higher body height (OR:1.03; 95%CI:1.01,1.04;P < 0.001), Russian ethnicity (OR:1.38; 95%CI:1.13,1.70;P = 0.002), lower ankle-brachial index (OR:0.19; 95%CI:0.11,0.30;P < 0.001), higher prevalence of lower backache (OR:1.29; 95%CI:1.08,1.52;P = 0.004), cardiovascular disease (OR:2.32; 95%CI:1.92,2.78;P < 0.001) and thyroid disease (OR:1.41; 95%CI:1.04,1.92;P = 0.03), lower international normalized ratio (OR:0.55; 95%CI:0.32,0.95;P = 0.03), lower prevalence of current smoking (OR:0.67; 95%CI:0.50,0.89;P = 0.006), and higher prevalence of alcohol consumption (OR:1.35; 95%CI:1.11,1.64;P = 0.003). Out of 1124 UVOS participants (age:88.2 ± 2.7 years; range:85-100 years), MS was present in 485 individuals (prevalence:43.1%; 95%CI:40.3,46.1). The criteria of waist circumference, blood pressure, hyperglycemia, serum high-density lipoprotein concentration and serum triglyceride concentration were fulfilled by 853 (75.9%; 95%CI:73.4,78.4), 1057 (94.0%; 95%CI:92.7,95.4), 320 (26.9%; 95%CI:24.3,29.5), 525 (46.7%; 95%CI:43.8,49.6), and 337 (30.0%; 95%CI:27.3,32.7, individuals, respectively. Higher MS prevalence was associated with female sex (OR:2.30; 95%CI:1.72,3.09;P < 0.001) and higher serum concentration of aspartate transaminase (OR:1.02; 95%CI:1.01,1.03;P = 0.007). Conclusions: MS is common in Russia, increases with age up to about 70 years and then plateaus, is more common in women, and differs in its associated factors between middle-aged and very old populations.

Concurrent vision and hearing impairment associated with cognitive dysfunction in a population aged 85+ years: the Ural Very Old Study.

OBJECTIVE: To assess the prevalence of vision impairment, hearing impairment and dual sensory impairment (DSI) as combination of vision and hearing impairment, in association with cognitive dysfunction in a population aged 85+ years. METHODS: The cross-sectional population-based Ural Very Old Study, conducted in rural and urban Bashkortostan, Russia, between 2017 and 2020, included a detailed ocular and systemic examination with assessment of moderate to severe vision impairment (MSVI)/blindness (best-corrected visual acuity <6/18), moderate to severe hearing loss (MSHL) and cognitive function. SETTING: A rural and urban area in Bashkortostan, Russia. PARTICIPANTS: Out of 1882 eligible individuals aged 85+ years, 1526 (81.1%) individuals participated. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of vision, hearing and DSI and cognitive dysfunction. RESULTS: The study included 731 (47.9%) individuals (mean age 88.1±2.7 years; median 87 years, range 85-98 years) with measurements of MSVI/blindness, MSHL and cognitive function. The prevalence of MSVI/blindness, MSHL, DSI and dementia were 51.8% (95% CI 48.2% to 55.5%), 33.1% (95% CI 29.7% to 36.5%), 20.5% (95% CI 17.8% to 23.5%) and 48.2% (95% CI 44.5% to 51.8%), respectively. Lower cognitive function score was associated with lower visual acuity (p<0.001) and higher hearing loss score (p=0.03), after adjusting for older age (p=0.001), rural region of habitation (p=0.003), lower educational level (p<0.001) and higher depression score (p<0.001). Higher dementia prevalence was associated with higher MSHL prevalence (OR 2.18 95% CI 1.59 to 2.98; p<0.001), higher MSVI/blindness prevalence (OR 2.09, 95% CI 1.55 to 2.81; p<0.001) and higher DSI prevalence (OR 2.80, 95% CI 1.92 to 4.07; p<0.001). CONCLUSIONS: In this very old, multiethnic population from Russia, DSI (prevalence 20.5%), as compared with hearing impairment (OR 2.18) and vision impairment alone (OR 2.09), had a stronger association (OR 2.80) with dementia. The findings show the importance of hearing and vision impairment, in particular their combined occurrence, for dementia prevalence in an old population.

Prevalence and determinants of reticular pseudodrusen in the Russian Ural Eye and Medical Study.

PURPOSE: To assess the prevalence of reticular pseudodrusen (RPD) and their determinants. METHODS: The Population-based Ural Eye and Medical Study conducted in Bashkortostan/Russia included 5899 participants aged 40+ years. Presence of RPDs was assessed on conventional colour fundus photographs, red-free fundus images and optical coherence tomographic images. RESULTS: The study included 4914 (83.3%) individuals (mean age: 58.5 ± 10.5 years; range: 40-94 years). Using two age limits (>55 years and 40+ years) for the definitions of RPD and AMD (age-related macular degeneration), RPD prevalence was 186/4914 (3.8%; 95% confidence interval (CI): 3.3, 4.3) and 246/4914 (5.0%, 95% CI: 4.4, 5.6), respectively, and the prevalence of any AMD without RPD was 182/4914 (3.7%: 95% CI: 3.2, 4.2) and 224/4914 (4.6%; 95% CI: 4.0, 5.1) respectively. Within the subgroup of early AMD, intermediate AMD and late AMD, RPD prevalence (age limit: 40+ years) was 55.1% (95% CI: 49.5, 60.8), 42.9% (95% CI: 33.8, 51.9) and 33.3% (95% CI: 16.4, 50.3) respectively. In multivariable analysis, higher RPD prevalence (age limit 40+ years) was associated with higher age (odds ratio (OR): 1.08; 95% CI: 1.07, 1.10; p < 0.001), rural region of habitation (OR: 3.81; 95% CI: 2.76, 5.24; p < 0.001) and lower percentage of lymphocytes on leukocyte counts (OR: 0.95; 95% CI: 0.93, 0.97; p < 0.001). Higher prevalence of any AMD without RPD was associated with urban region (OR: 1.58; 95% CI: 1.18, 2.11; p = 0.002), lower diabetes prevalence (OR: 0.55; 95% CI: 0.33, 0.90; p = 0.02) and shorter axial length (OR: 0.85; 95% CI: 0.74, 0.98; p = 0.03), after adjusting for age. CONCLUSIONS: Reticular pseudodrusen (mean prevalence: 3.8% (age limit >55 years); 5.0% (age limit 40+ years)) differs from AMD without RPD in its association with urban region (AMD without RPD: rural region), lower lymphocyte percentage (AMD without RPD: no association) and a lack of associations with axial length (AMD without RPD: shorter axial length) and with diabetes prevalence (AMD without RPD: lower diabetes prevalence).

Ankle-brachial index and ocular diseases in a Russian population.

BACKGROUND: To assess potential associations between the ankle-brachial blood pressure index (ABI) and ocular disorders. METHODS: In the population-based cross-sectional Russian Ural Eye and Medical Study including 5,899 (80.5%) out of 7328 eligible participants aged 40+ years, the participants underwent a series of ocular and medical examinations including measurement of ABI. RESULTS: Blood pressure measurements of both arms and ankles were available for 3187 (54.0%) individuals. The mean ABI was 1.26 ± 0.19 (median:1.20; range: 0.61, 2.20). In multivariate analysis, a higher ABI was associated with younger age (P < 0.001; non-standardized regression coefficient B: -0.001; 95% confidence interval (CI): -0.002, -0.001), female sex (P < 0.001; B: 0.03; 95% CI: 0.02, 0.04), lower body mass index (P < 0.001; B: -0.004; 95% CI: -0.006, -0.003), lower waist-to-hip ratio (P = 0.01; B: -0.10; 95% CI: -0.17, -0.02), lower glucose serum concentration (P = 0.008; B: -0.005; 95% CI: -0.009, -0.001), lower prevalence of arterial hypertension (P < 0.001; B: -0.14; 95% CI: -0.16, -0.12), higher mean systolic blood pressure (P < 0.001; B: 0.003; 95% CI: 0.002, 0.003), and higher prevalence of any alcohol consumption (P < 0.001; B: 0.03; 95% CI: 0.02, 0.04). In that multivariate model, prevalence of glaucoma (P = 0.67) as a whole, open-angle glaucoma (P = 0.86) and angle-closure glaucoma (P = 0.54), stage of glaucomatous optic neuropathy (P = 0.57), prevalence of age-related macular degeneration (P = 0.88), prevalence and stage of diabetic retinopathy (P = 0.30, and P = 0.29, respectively), nuclear cataract (P = 0.32, and P = 0.41, resp.), cortical cataract (P = 0.33, and P = 0.92, resp.), subcapsular cataract (P = 0.74 and P = 0.60, resp.), and pseudoexfoliation (P = 0.44 and P = 0.47, resp.), intraocular pressure (P = 0.52), axial length (P = 0.20), and peripapillary retinal nerve fibre layer thickness (P = 0.55) were not significantly associated with the ABI. CONCLUSIONS: In this ethnically mixed population from Russia, none of the major ocular diseases was associated with ABI suggesting that subclinical atherosclerosis is not markedly associated with the aetiology of these ocular disorders.

The prevalence of dry eye in a very old population.

PURPOSE: To assess the prevalence of dry eye disease (DED) and Meibomian gland dysfunction (MGD) in a very old population. METHODS: The Ural Very Old Study (UVOS), a population-based cohort study performed in rural and urban Bashkortostan/Russia, included 1526 (81.1%) out of 1882 eligible individuals aged 85+ years. The participants underwent a detailed medical and ophthalmological examination including Schirmer´s test, slit-lamp based assessment of the Meibomian glands and an interview. RESULTS: The study included 1493 (97.8%) individuals with available information about DED (mean age: 88.3 ± 2.9 years). Schirmer´s test was ≤5 mm in 388 individuals (34.3%; 95% confidence interval (CI): 31.5, 37.1), and the mean score of subjective dry eye symptoms was 7.52 ± 2.14 (median: 6; range: 6-18; 95%CI: 7.41, 7.63). An MGD grade 1, 2, 3 and 4 was diagnosed in 367 (31.4%), 309 (26.4%), 89 (7.6%) and 39 (3.3%) eyes, respectively. The prevalence of DED diagnosis definition #2 (dry eye score ≥8, Schirmer´s test ≤5 mm) and definition #4 (dry eye score ≥7, Schirmer test ≤5 mm, MGD grade 1+), were 164/1132 (14.5%; 95%CI: 12.4, 16.5), and 167/1131 (14.8%; 95%CI: 12.7, 16.8), respectively. In multivariate analysis, higher DED prevalence was associated with female sex (odds ratio (OR): 2.36; 95%CI: 1.18, 4.71; p = 0.02), rural region of habitation (OR: 2.72; 95%CI: 1.10, 6.70; p = 0.03), longer axial length (OR: 1.30; 95%CI: 1.04,1.62; p = 0.02), higher hearing loss score (OR: 1.03; 95%CI: 1.01, 1.05; p = 0.001) and lower self-reported salt consumption (OR: 0.64; 95%CI: 0.54, 0.75; p < 0.001). CONCLUSIONS: In this population-based recruited very old study sample aged 85+ years, higher DED prevalence (dry eye score ≥8, Schirmer´s test <5 mm; mean: 14.5%) and MGD prevalence (any grade:68.8%) was associated with female sex, rural region of habitation, longer axial length, higher hearing loss score and lower salt consumption.

Prevalence and Associated Factors of Diabetic Retinopathy in a Russian Population. The Ural Eye and Medical Study.

AIM: To assess prevalence and associated factors of diabetic retinopathy (DR) in a Russian population. METHODS: Out of 7328 eligible individuals, the population-based cross-sectional Ural Eye and Medical Study included 5899 (80.5%) individuals aged 40+ years, who underwent a detailed medical and ophthalmological examination. Using ocular fundus photographs and optical coherence tomographic images, we assessed prevalence and degree of DR in 5105 participants. RESULTS: DR was present in 99/5105 individuals (1.9%; 95% confidence interval [CI]: 1.6, 2.3). Its prevalence increased from 6/657 (1.0%; 95% CI: 0.2, 1.6) in the age group of 45-50 years to 24/680 (3.5%; 95% CI: 2.1, 4.9) in the age group of 65-70 years, and decreased to 3/153 (2.0%; 95% CI: 0.00, 4.2) in the age group of 80+ years. DR prevalence within the 577 (11.4%; 95% CI: 10.5, 12.2) individuals with diabetes was 99/577 (17.2%; 95% CI: 14.1, 20.2). DR was the cause for moderate-to-severe vision impairment (best corrected visual acuity <6/18 but ≥3/60) in four individuals (4/5105; 0.07%). In multivariable analysis, higher DR prevalence was associated with higher serum glucose concentration (odds ratio [OR]: 1.30; 95% CI: 1.20, 141), longer diabetes duration (OR: 1.06; 95% CI: 1.02, 1.09), type of diabetes therapy (nil/diet/oral/insulin) (OR:4.19;95% CI:3.08, 5.70), lower educational level (OR:0.81;95% CI:0.67, 0.98), lower manual dynamometric force (OR: 0.96; 95% CI: 0.94, 0.99), shorter ocular axial length (OR: 0.73; 95% CI: 0.56, 0.96), and higher diastolic blood pressure (OR: 1.04; 95% CI: 1.01, 1.06), or alternatively, higher estimated cerebrospinal fluid pressure (OR: 1.09; 95% CI: 1.01, 1.18). CONCLUSION: In this urban and rural Russian population aged 40+ years, DR prevalence was relatively low (1.9%; 95% CI: 1.6, 2.3), showed an inverted U-shaped association with age, and in a cross-sectional study design it was associated with shorter axial length and higher estimated cerebrospinal fluid pressure.

Axial length and its associations in the Ural Very Old Study.

To assess the distribution of axial length as surrogate for myopia and its determinants in an old population, we performed the Ural Very Old Study as a population-based cohort study. Out of 1882 eligible individuals aged 85 + years, the Ural Very Old Study performed in an urban and rural region in Bashkortostan/Russia included 1526 (81.1%) individuals undergoing ophthalmological and medical examinations with sonographic axial length measurement. Biometric data were available for 717 (47.0%) individuals with a mean age of 88.0 ± 2.6 years (range 85-98 years; 25%). Mean axial length was 23.1 ± 1.1 mm (range 19.37-28.89 mm). Prevalences of moderate myopia (axial length 24.5-< 26.5 mm) and high myopia (axial length ≥ 26.5 mm) were 47/717 (6.6%; 95% CI 4.7, 8.4) and 10/717 (1.4%; 95% CI 0.5, 2.3), respectively. In multivariable analysis, longer axial length was associated (coefficient of determination r2 0.25) with taller body height (standardized regression coefficient beta:0.16;non-standardized regression coefficient B: 0.02; 95% confidence interval (CI) 0.01, 0.03; P < 0.001), higher level of education (beta: 0.12; B: 0.07; 95% CI 0.02, 0.11; P = 0.002), and lower corneal refractive power (beta: - 0.35; B: - 0.23; 95% CI - 0.28, - 0.18; P < 0.001). Higher prevalence of moderate myopia, however not of high myopia, was associated with higher educational level (OR 1.39; 95% CI 1.09, 1.68; P = 0.007) and lower corneal refractive power (OR 0.77; 95% CI 0.63, 0.94; P = 0.01). In this old study population, prevalence of moderate axial myopia (6.6% versus 9.7%) was lower than, and prevalence of high axial myopia (1.4% versus 1.4%) was similar as, in a corresponding study on a younger population from the same Russian region. Both myopia prevalence rates were higher than in rural Central India (1.5% and 0.4%, respectively). As in other, younger, populations, axial length and moderate myopia prevalence increased with higher educational level, while high myopia prevalence was independent of the educational level.

Prevalence Factors Associated With Vision Impairment and Blindness Among Individuals 85 Years and Older in Russia.

Importance: Visual performance is important for quality of life. However, vision impairment among adults 85 years and older has not been intensively examined. Objective: To assess the prevalence of mild vision impairment (VI), moderate to severe vision impairment, and blindness and the factors associated with these conditions among a population 85 years and older. Design, Setting, and Participants: The Ural Very Old Study was a population-based cohort study conducted in rural and urban areas in Bashkortostan, Russia from 2017 to 2020. Among 1882 eligible individuals 85 years and older, 1526 participants (81.1%) were enrolled. Exposures: Ophthalmologic, physical, and mental examinations. Main Outcomes and Measures: Prevalence of vision impairment and blindness based on best-corrected visual acuity (BCVA; measured using modified Early Treatment of Diabetic Retinopathy Study charts) in the better eye or both eyes. Mild vision impairment was defined as BCVA worse than 6/12 to 6/18, and moderate to severe VI was defined as BCVA worse than 6/18 but equal to or better than 3/60. Blindness was defined as BCVA worse than 3/60. Results: Among 1526 participants, 1149 individuals (75.3%; 846 women [73.6%]; mean [SD] age, 88.2 [2.8 years]) had available BCVA measurements and were included in the present analysis. Mild vision impairment was present in 114 individuals (9.9%; 95% CI, 8.2%-11.7%), moderate to severe VI in 562 individuals (48.9%; 95% CI, 46.0%-51.8%), and blindness in 68 individuals (5.9%; 95% CI, 4.6%-7.3%). Factors associated with moderate to severe VI were cataracts (324 individuals [57.7% of those with moderate to severe VI and 28.2% of total population; 95% CI, 25.6%-30.8%]), secondary cataracts (4 individuals [0.7% of those with moderate to severe VI and 0.3% of total population; 95% CI, 0%-0.7%]), age-related macular degeneration (78 individuals [13.9% of those with moderate to severe VI and 6.8% of total population; 95% CI, 5.3%-8.3%]), glaucoma (45 individuals [8.0% of those with moderate to severe VI and 3.9% of total population; 95% CI, 2.8%-5.0%]), corneal opacifications (26 individuals [4.6% of those with moderate to severe VI and 2.3% of total population; 95% CI, 1.4%-3.1%]), myopic maculopathy (13 individuals [2.3% of those with moderate to severe VI and 1.1% of total population; 95% CI, 0.5%-1.7%]), and nonglaucomatous optic nerve damage (4 individuals [0.7% of those with moderate to severe VI and 0.3% of total population; 95% CI, 0%-0.7%]). Factors associated with blindness were cataracts (33 individuals [48.5% of those with blindness and 2.9% of total population; 95% CI, 1.9%-3.8%]), age-related macular degeneration (15 individuals [22.1% of those with blindness and 1.3% of total population; 95% CI, 0.7%-2.0%]), glaucoma (7 individuals [10.3% of those with blindness and 0.6% of total population; 95% CI, 0.2%-1.1%]), myopic maculopathy (3 individuals [4.4% of those with blindness and 0.3% of total population; 95% CI, 0%-0.6%]), and corneal opacifications (2 individuals [2.9% of those with blindness and 0.2% of total population; 95% CI, 0%-0.4%]). Higher moderate to severe VI prevalence was associated with older age (odds ratio [OR], 1.19; 95% CI, 1.11-1.28; P < .001), higher blood pressure (OR, 1.01; 95% CI, 1.00-1.02; P = .03), lower hand grip force (OR, 0.88; 95% CI, 0.83-0.95; P < .001), lower score on the Mini-Mental State Examination (OR, 0.95; 95% CI, 0.92-0.98; P < .001), lower prothrombin index (OR, 0.93; 95% CI, 0.89-0.97; P < .001), lower refractive error (OR, 0.91; 95% CI, 0.85-0.97; P = .006), and lower prevalence of previous cataract surgery (OR, 0.48; 95% CI, 0.33-0.68; P < .001). Conclusions and Relevance: In this cohort study of individuals 85 years and older, the prevalence of moderate to severe VI and blindness was relatively high. Cataracts were the main reversible condition associated with vision loss, and age-related macular degeneration, glaucoma, and myopic maculopathy were the main irreversible conditions. Because a higher prevalence of moderate to severe VI was associated with lower cognitive function and physical strength, improvement of vision through increases in cataract surgery and measures to prevent and treat irreversible conditions may help to improve cognitive function and physical strength.