https://www.sciencedirect.com/science/article/pii/S0735109726056457
Among the 2.52 million participants (mean age: 70.67 years), 42.5% had VA impairment. Over a mean follow-up of 4.99 years (accumulating 12,560,718.9 person-years), 348,501 deaths occurred, including 153,758 CVD deaths. In the fully adjusted model, each 1-logMAR unit increase in BVA (greater visual impairment) was associated with a 3% higher risk of all-cause mortality (HR: 1.03; 95% CI: 1.03-1.04) and a 3% higher risk of CVD mortality (HR: 1.03; 95% CI: 1.02-1.03). A graded association was observed when VA was categorized by quartiles, with the worst quartile (Q4) showing significantly elevated risks for all-cause (HR: 1.25; 95% CI: 1.24-1.26) and CVD mortality (HR: 1.30; 95% CI: 1.28-1.32) compared to the best quartile (Q1). Stratified analysis indicated that the association was stronger in younger participants (65-70 years). Dose-response analysis revealed a significant nonlinear association, with mortality risk rising steeply at lower levels of impairment and plateauing at higher levels. Competing risk and sensitivity analysis confirmed the robustness of these findings.