Analysis of glaucoma-related mortality in the United States using death certificate data.

PURPOSE: Recent studies have reported a connection between glaucoma and decreased survival. To evaluate the underlying causes of glaucoma-related mortality, we searched vital records data for deaths citing glaucoma and reviewed the demographic variables and comorbidities contained on these records.

MATERIALS AND METHODS: Deaths including glaucoma, as either an underlying cause or a contributing cause of death, were selected from US multiple-cause-of-death data for the years 1990 to 2003 and combined with population data from the US Census Bureau to calculate mortality rates. Logistic regression was used to determine whether reporting of accidents and/or selected systemic disorders are associated with glaucoma on the death certificate.

RESULTS: Fifteen thousand two hundred twenty-eight glaucoma-related deaths (0.05%) were identified during the years under study. Black males had the highest glaucoma-related mortality rate with 9.4 deaths per 1,000,000 persons annually, whereas Hispanic females had the lowest mortality rate at 1.8 deaths per 1,000,000. After adjusting for age, sex, and race/ethnicity, positive associations were found between glaucoma and hypertension [Odds ratio (OR): 4.89; 95% confidence interval (CI)=4.73-5.05], diabetes (OR: 2.60; 95% CI=2.50-2.71), asthma (OR: 3.14; 95% CI=2.72-3.62), and accidents of all types (OR: 1.45; 95% CI=1.35-1.55).

CONCLUSIONS: Glaucoma is an important contributor to mortality for certain individuals. The disparities in mortality rates observed among race/ethnic strata may be attributed to differences in access to care as well as true differences in disease incidence and/or severity among racial groups. Despite limitations with the data, our findings suggest associations between glaucoma and a number of comorbid conditions. These associations should be explored in future studies and serve to guide strategies for disease management and prevention.