Visual Impairment and Cardiovascular Risk Factors in Hispanic and Latino Adults

Importance: Visual impairment (VI) affects approximately 7 million individuals in the US and is associated with adverse outcomes; cardiovascular disease (CVD) risk factors and nonmedical drivers of health (NMDOH) may contribute. Prior research in Mexican American individuals suggested high VI prevalence, but data across more diverse US Hispanic/Latino populations remain limited. Objective: To estimate VI prevalence and assess its associations with CVD risk factors in Hispanic/Latino adults in the US. Design, Setting, and Participants: This cross-sectional study analyzed data from SOL Ojos, an ancillary study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Participants were Hispanic/Latino adults aged 40 years or older from community-based cohorts in Chicago, Illinois, and Miami, Florida, who completed HCHS/SOL visit 3 (2020-2024) and were recruited into SOL Ojos from July 1, 2021, to July 1, 2023. Exposures: Individual and cumulative major CVD risk factors: diabetes, hypercholesterolemia, hypertension, obesity, and smoking. Main Outcome and Measures: Age-standardized VI (visual acuity less than or equal to 20/40 in the better-seeing eye), assessed by habitual visual acuity, best-corrected visual acuity, and uncorrected refractive error (correctable to more than 20/40). Odds ratios (ORs) for VI by CVD risk factors were estimated using logistic regression, sequentially adjusting for traditional, biologic, and NMDOH-related confounders. Age-standardized weighted estimates reflected the target population. Results: Among 3288 participants (mean age, 58.7 [95% CI, 57.9-59.5] years; 61.9% [95% CI, 60.2%-63.5%] female), VI prevalence by habitual visual acuity was 7.1% (95% CI, 5.3%-8.8%) in men vs 7.0% (95% CI, 5.2%-8.8%) in women and by best-corrected visual acuity was 1.8% (95% CI, 1.0%-2.6%) in men vs 2.6% (95% CI, 1.6%-3.7%) in women; VI by uncorrected refractive error was 5.2% (95% CI, 3.7%-6.8%) in men vs 4.4% (95% CI, 3.0%-5.8%) in women. VI prevalence varied across Hispanic/Latino backgrounds in men (habitual visual acuity VI range, 4.1% [95% CI, 1.8%-6.4%] to 16.9% [95% CI, 11.6%-22.2%]; uncorrected refractive error range, 2.3% [95% CI, 0.6%-4.0%] to 13.5% [95% CI, 8.1%-18.9%]) and was highest among Mexican men. In fully adjusted models, diabetes was associated with VI assessed by best-corrected visual acuity (OR, 4.65; 95% CI, 2.42-8.91), as were cumulative CVD risk factors vs 1 or none (3 factors: OR, 3.47 [95% CI, 1.45-8.33]; ≥4 factors: OR, 9.80 [95% CI, 4.34-22.13]). ORs were smaller when VI was assessed by habitual visual acuity (eg, diabetes OR, 2.03 [95% CI, 1.37-3.01]). Conclusions and Relevance: In this cross-sectional study of US Hispanic/Latino adults, VI and CVD risk factor prevalence varied by ethnic background, and diabetes and cumulative CVD risk factors were associated with VI. The findings provide updated prevalence estimates and support the need for longitudinal studies of causal relationships between VI and CVD risk factors.