Baseline Cataract Status and 11-year Mortality: A Population-Based Study from a Mediterranean Population Maria Pastor-Valero 1,2* , Juan Jose Miralles-Bueno 1 and Vicente Chaqués-Alepuz 3,4 1 Department of Public Health, History of Science and Gynaecology, Faculty of Medicine, (Muhammad Al- Shafra Building), Miguel Hernández University, Spain 2 CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain 3 Head of Ophthalmology Department, Arnau de Vilanova Hospital, Valencia, Spain 4 Department of Ophthalmology, Valencia University, Spain * Corresponding author: Dr. María Pastor-Valero, Department of Public Health, History of Science and Gynaecology, Faculty of Medicine, (Muhammad Al- Shafra Building), Miguel Hernández University, Spain, Tel: (+34) 96 591 9506; Fax: 96 591 9551; E-mail: mpastor@umh.es, miralles_juabue@gva.es Received date: Nov 26, 2014, Accepted date: Feb 26, 2015, Published date: Feb 28, 2015 Copyright: © 2015 Pastor-Valero M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Purpose: To examine the relationship between cataract, previous cataract surgery and risk of mortality in an elderly Mediterranean population. Methods: This is a survival analysis of data from the Spanish centre of the European Eye Study (EUREYE) to examine 11-year-mortality risk among participants with previous cataract surgery or cataract compared to non- cataract participants diagnosed at the start of the study. Results: After adjustment for age-related maculopathy (ARM), age, smoking, physical activity, obesity, diabetes mellitus, hypertension, previous stroke and heart attack, only the cataract no surgery group in men showed a significant elevated increased risk of mortality. The adjusted Hazard Ratio (HR) for the cataract no surgery men was, 1.96 95% CI (1.11-3.47) p=0.020 compared to non-cataract men. Conclusion: We observed an increased risk of mortality in men with cataract in this elderly population. These results might indicate a differential use of medical services by elderly men compared to women. In addition, the lack of an increased mortality risk among the cataract surgery groups might be explained by the improvement in visual function. Future studies should include information on medical care use as well as information on measurements of pre and post-operative visual acuity. Keywords Cataract; Mortality; Mediterranean population; Survival analysis Introduction The mechanism by which cataract might cause increased mortality is unknown but various hypotheses have been put forward. Studies have suggested that age-related cataract may be a marker of premature aging reflecting systemic diseases and early mortality [1]. Excess mortality has also been associated with poor vision, which could increase accident rates, loss of independence, and decreased social interaction leading to depression and higher cardiovascular mortality [2]. Cataract surgical complications have also been pointed out as one cause of excess mortality [1,3-7], but progress in phacoemulsification techniques have improved surgical safety and efficiency [2]. Moreover, studies have suggested that deaths due to cataract surgical complications are low, even for patients at higher preoperative risk [1,8]. Cataract, defined by the occurrence of past cataract surgery or as prevalent cases of cataract, has generally been shown to be associated with increased mortality either in the total study population [9] or in subpopulations defined by diabetic status [10-12]. However, none of these studies adjusted for the possible confounding effect of smoking. When other studies did, results continue to suggest an association between either some types of cataract [13-16] or with cataract (cataract cases or past cataract surgery) and mortality [17]. However, some large population-based studies have not found any association between mortality and cataract. Results from the 12-year follow-up US male Physicians´ Health cohort study indicated no association between reported history of cataract and increased mortality [18]. In this study, the general good health of the study population was mentioned as a limitation to the detection of an association. In fact, men with a previous history of myocardial infarction, stroke, cancer etc. we’re not eligible for inclusion. In two other large prospective population based studies, the Rotterdam cohort study [19] and the Beaver Dam Eye Study [20], and in the Medical Research Council (MRC) trial of assessment and management of older people in the community [21], an association was observed between cataract and mortality when adjusted by age and gender, but disappeared after correcting for all additional confounders. In a recent Chinese prospective population based study no type of cataract was associated with higher mortality [22]. With increasing survival of older people worldwide, cataract incidence and surgery will also increase. If cataract is established as a predictor of general frailty and early mortality then a comprehensive understanding of the role of cataract as a potential marker within the ageing process would help to design preventive policies for active Pastor-Valero et al., J Clin Exp Ophthalmol 2015, 6:1 DOI: 10.4172/2155-9570.1000403 Research Article Open Access J Clin Exp Ophthalmol ISSN:2155-9570 JCEO, an open access journal Volume 6 • Issue 1 • 1000403 Journal of Clinical & Experimental Ophthalmology J o ur n a l o f C l i n ic a l & E x pe r i m e n t a l O p h t h a l m o lo g y ISSN: 2155-9570