Risk of musculoskeletal injuries, fractures, and falls in medicare beneficiaries with disorders of binocular vision

Stacy L. Pineles, Michael X Repka, Fei Yu, Flora Lum, Anne L. Coleman

Research output: Contribution to journalArticle

Abstract

IMPORTANCE: Disorders of binocular vision are increasingly prevalent among fee-for-service Medicare beneficiaries 65 years or older. Visual impairment is a recognized risk factor for fractures. Despite the association of visual impairment and fracture risk, to our knowledge, no study has examined the influence that disorders of binocular vision (strabismus, amblyopia, diplopia, and nystagmus) may have on musculoskeletal injury and fracture risk in the elderly population. OBJECTIVE: To evaluate associations between disorders of binocular vision and musculoskeletal injury, fracture, and falls in the elderly. DESIGN, SETTING, AND PARTICIPANTS: A retrospective study of 10-year (2002-2011) musculoskeletal injury, fracture, or fall prevalence in a 5% random sample of Medicare Part B fee-for-service claims for beneficiaries with disorders of binocular vision. Participants included Medicare beneficiaries living in the general community who were 65 years or older with at least 1 year of Medicare Part B enrollment. EXPOSURES: Diagnosis of a disorder of binocular vision. MAIN OUTCOMES AND MEASURES: Ten-year prevalence of musculoskeletal injury, fracture, or fall in individuals with and without disorders of binocular vision. Analyses were adjusted for age, sex, race/ethnicity, region of residence, systemic and ocular comorbidities, and duration of follow-up. RESULTS: There were 2 196 881 Medicare beneficiaries identified. Of these, 99 525 (4.5%) had at least 1 reported disorder of binocular vision (strabismus, 2.3%; diplopia, 2.2%; amblyopia, 0.9%; and nystagmus, 0.2%). During the 10-year study period, there were 1 272 948 (57.9%) patients with documented musculoskeletal injury, fracture, or fall. The unadjusted odds ratio (OR) for the association between disorders of binocular vision and any of the 3 injury types was 2.23 (95% CI, 2.20-2.27; P <.001). The adjusted OR was 1.27 (95% CI, 1.25-1.29; P <.001). CONCLUSIONS AND RELEVANCE: Medicare beneficiaries with a disorder of binocular vision have significantly higher odds of sustaining a musculoskeletal injury, fracture, or fall. This finding is an important step forward in understanding and developing strategies to prevent these injuries, which are associated with high morbidity in the elderly.

Original languageEnglish (US)
Pages (from-to)60-65
Number of pages6
JournalJAMA Ophthalmology
Volume133
Issue number1
DOIs
StatePublished - Jan 1 2015

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Binocular Vision
Medicare
Wounds and Injuries
Medicare Part B
Fee-for-Service Plans
Amblyopia
Diplopia
Strabismus
Vision Disorders
Odds Ratio
Comorbidity
Retrospective Studies
Morbidity

ASJC Scopus subject areas

  • Ophthalmology
  • Medicine(all)

Cite this

Risk of musculoskeletal injuries, fractures, and falls in medicare beneficiaries with disorders of binocular vision. / Pineles, Stacy L.; Repka, Michael X; Yu, Fei; Lum, Flora; Coleman, Anne L.

In: JAMA Ophthalmology, Vol. 133, No. 1, 01.01.2015, p. 60-65.

Research output: Contribution to journalArticle

Pineles, Stacy L. ; Repka, Michael X ; Yu, Fei ; Lum, Flora ; Coleman, Anne L. / Risk of musculoskeletal injuries, fractures, and falls in medicare beneficiaries with disorders of binocular vision. In: JAMA Ophthalmology. 2015 ; Vol. 133, No. 1. pp. 60-65.
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N2 - IMPORTANCE: Disorders of binocular vision are increasingly prevalent among fee-for-service Medicare beneficiaries 65 years or older. Visual impairment is a recognized risk factor for fractures. Despite the association of visual impairment and fracture risk, to our knowledge, no study has examined the influence that disorders of binocular vision (strabismus, amblyopia, diplopia, and nystagmus) may have on musculoskeletal injury and fracture risk in the elderly population. OBJECTIVE: To evaluate associations between disorders of binocular vision and musculoskeletal injury, fracture, and falls in the elderly. DESIGN, SETTING, AND PARTICIPANTS: A retrospective study of 10-year (2002-2011) musculoskeletal injury, fracture, or fall prevalence in a 5% random sample of Medicare Part B fee-for-service claims for beneficiaries with disorders of binocular vision. Participants included Medicare beneficiaries living in the general community who were 65 years or older with at least 1 year of Medicare Part B enrollment. EXPOSURES: Diagnosis of a disorder of binocular vision. MAIN OUTCOMES AND MEASURES: Ten-year prevalence of musculoskeletal injury, fracture, or fall in individuals with and without disorders of binocular vision. Analyses were adjusted for age, sex, race/ethnicity, region of residence, systemic and ocular comorbidities, and duration of follow-up. RESULTS: There were 2 196 881 Medicare beneficiaries identified. Of these, 99 525 (4.5%) had at least 1 reported disorder of binocular vision (strabismus, 2.3%; diplopia, 2.2%; amblyopia, 0.9%; and nystagmus, 0.2%). During the 10-year study period, there were 1 272 948 (57.9%) patients with documented musculoskeletal injury, fracture, or fall. The unadjusted odds ratio (OR) for the association between disorders of binocular vision and any of the 3 injury types was 2.23 (95% CI, 2.20-2.27; P <.001). The adjusted OR was 1.27 (95% CI, 1.25-1.29; P <.001). CONCLUSIONS AND RELEVANCE: Medicare beneficiaries with a disorder of binocular vision have significantly higher odds of sustaining a musculoskeletal injury, fracture, or fall. This finding is an important step forward in understanding and developing strategies to prevent these injuries, which are associated with high morbidity in the elderly.

AB - IMPORTANCE: Disorders of binocular vision are increasingly prevalent among fee-for-service Medicare beneficiaries 65 years or older. Visual impairment is a recognized risk factor for fractures. Despite the association of visual impairment and fracture risk, to our knowledge, no study has examined the influence that disorders of binocular vision (strabismus, amblyopia, diplopia, and nystagmus) may have on musculoskeletal injury and fracture risk in the elderly population. OBJECTIVE: To evaluate associations between disorders of binocular vision and musculoskeletal injury, fracture, and falls in the elderly. DESIGN, SETTING, AND PARTICIPANTS: A retrospective study of 10-year (2002-2011) musculoskeletal injury, fracture, or fall prevalence in a 5% random sample of Medicare Part B fee-for-service claims for beneficiaries with disorders of binocular vision. Participants included Medicare beneficiaries living in the general community who were 65 years or older with at least 1 year of Medicare Part B enrollment. EXPOSURES: Diagnosis of a disorder of binocular vision. MAIN OUTCOMES AND MEASURES: Ten-year prevalence of musculoskeletal injury, fracture, or fall in individuals with and without disorders of binocular vision. Analyses were adjusted for age, sex, race/ethnicity, region of residence, systemic and ocular comorbidities, and duration of follow-up. RESULTS: There were 2 196 881 Medicare beneficiaries identified. Of these, 99 525 (4.5%) had at least 1 reported disorder of binocular vision (strabismus, 2.3%; diplopia, 2.2%; amblyopia, 0.9%; and nystagmus, 0.2%). During the 10-year study period, there were 1 272 948 (57.9%) patients with documented musculoskeletal injury, fracture, or fall. The unadjusted odds ratio (OR) for the association between disorders of binocular vision and any of the 3 injury types was 2.23 (95% CI, 2.20-2.27; P <.001). The adjusted OR was 1.27 (95% CI, 1.25-1.29; P <.001). CONCLUSIONS AND RELEVANCE: Medicare beneficiaries with a disorder of binocular vision have significantly higher odds of sustaining a musculoskeletal injury, fracture, or fall. This finding is an important step forward in understanding and developing strategies to prevent these injuries, which are associated with high morbidity in the elderly.

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