Mortality and suicide risk in glaucoma patients with or without vision impairment: a nationwide cohort study

This study aimed to investigate the mortality and suicide risk in glaucoma patients with or without vision impairment. Data were retrieved from the Korean National Health Insurance Service for 4,056,650 individuals aged ≥ 20 years and assessed for all-cause and cause-specific mortality for glaucoma from 2009 to 2020. Subjects were classified into 3 groups: healthy control subjects, glaucoma without vision impairment, and glaucoma with vision impairment. Hazard ratios (HR) were calculated under crude and five adjusted models with epidemiologic variables. Analyses of subjects stratified by age and sex were conducted among 3 groups to compare all-cause mortality rate. All-cause mortality significantly increased in both glaucoma without vision impairment ([HR] 3.171, 95% confidence interval [CI] 3.034-3.313) and glaucoma with vision impairment ([HR] 5.397, 95% [CI] 4.824-6.037) groups compared to the control group before adjustment. After adjusting for confounding factors, glaucoma patients with vision impairment showed significantly higher mortality (adjusted HR [aHR] of 1.346 (95% CI, 1.203-1.505). Cause-specific mortality analysis revealed elevated HRs for metabolic, circulatory, respiratory diseases, and suicide-related causes in the glaucoma with vision impairment group before and after adjustment. Of note, both glaucoma without vision impairment and glaucoma with vision impairment groups exhibited progressively increasing aHRs for suicide mortality, with the highest aHR of 2.486 (95% CI, 1.498-4.126) in the glaucoma with vision impairment group. Age and sex-stratified analysis indicated that glaucoma with vision impairment had significantly greater impact on all-cause mortality in younger age groups (P < 0.0001), especially in females (P = 0.0057). Suicide mortality in glaucoma individuals with vision impairment was similar in all age groups (P = 0.827) regardless of sex (P = 0.866). These results showed that overall mortality was increased in glaucoma individuals with vision impairment. In glaucoma without vision impairment, mortality from metabolic diseases and suicide was increased, whereas in glaucoma with vision impairment, mortality from metabolic, circulatory, respiratory diseases, and suicide was increased. Glaucoma with vision impairment had greater impact on overall mortality in younger age groups, especially in females, however, mortality from suicide was increased in all age groups regardless of sex.