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Importance Approximately 8 million Americans self-report vision loss and blindness (VL), potentially resulting in a significant economic burden. Objective Estimate the economic burden of VL in the US and by state. Design Analysis of secondary data sources (American Community Survey (ACS), American Time Use Survey, Bureau of Labor Statistics, Medical Expenditure Panel Survey (MEPS), National and State Health Expenditure Accounts (N/SHEA), National Health Interview Survey (NHIS)) using attributable fraction, regression, and other methods to estimate the incremental direct and indirect 2017 costs of VL. Participants People with a yes response to a question asking if they are blind or have serious difficulty seeing even when wearing glasses in the ACS, MEPS, or NHIS. Main Outcome Measures We estimated the direct costs of medical, nursing home (NH), and supportive services; and indirect costs of absenteeism, lost household production, reduced labor force participation, and informal care by age group (0-18 years, 19-64 years, 65+ years), sex (male, female), and state in aggregate and per person with VL. Results We estimated an economic burden of VL of $134.2bn, $98.7 bn in direct costs, and $35.5 bn in indirect costs. The most substantial burden components were NH ($41.8 bn), medical care services other than inpatient, ambulatory, and prescription care ($30.9 bn), and reduced labor force participation ($16.2 bn) which accounted for 66% of the total. Persons with VL incurred $16,838 per year in incremental burden. Informal care was the largest burden component for people ages 0-18 years, reduced labor force participation for people ages 19-64 years, and NH costs for people ages 65+ years. New York, Connecticut, Massachusetts, Rhode Island, and Vermont experienced the highest costs per person with VL. Sensitivity analyses indicate total burden may range between $76 and $218 bn depending on assumptions used in the model. Conclusions and Relevance Self-reported VL imposes a substantial economic burden on the US. Burden accrues in different ways at different ages, leading to state differences in the composition of per-person costs based on their VL population's age composition. Information on state variation can help local decision-makers better target resources to address the burden of VL.

The COVID-19 pandemic has had profound impacts on mental health. We examined whether mental health differed based on sociodemographic and background characteristics, political party affiliation, and concerns about COVID-19.A cross-sectional, national sample of 1095 U.S. adults were surveyed October 22-26, 2020. The survey collected information on demographics, risk and protective behaviors for COVID-19, and mental health using the Mental Health Inventory-5 (MHI-5) scale. Independent samples t-tests, one-way Analysis of Variance tests, and a multivariable linear regression model were conducted.Regression results showed respondents with criminal justice (B = -6.56, 95% CI = -10.05, -3.06) or opioid misuse (B = -9.98, 95% CI = -14.74, -5.23) histories reported poorer mental health than those without. Those who took protective behaviors (e.g., wearing masks) reported poorer mental health compared to those who indicated protective behaviors were unnecessary (B = 7.00, 95% CI = 1.61, 12.38) while those who took at least one risk behavior (e.g., eating in a restaurant) reported better mental health than those who did not.Our study shows that certain groups have experienced poorer mental health during the COVID-19 pandemic, suggesting that mental health should continue to be monitored so that public health interventions and messaging help prevent the spread of COVID-19 without increasing poor mental health outcomes.

We examined partner-seeking and sexual behaviors among a representative sample of U.S. adults (N = 1,161) during the first year of the COVID-19 pandemic. Approximately 10% of survey respondents sought a new partner, with age and sexual identity being associated with partner seeking behavior. Approximately 7% of respondents had sex with a new partner, which marks a decrease as compared to a pre-pandemic estimate from 2015 - 2016 in which 16% of U.S. adults reported having sex with a new partner during the past year. Among respondents who had in-person sex with a new partner during the first year of the pandemic, public health guidelines for in-person sexual activity were infrequently followed.

ImportanceRecent evidence suggests that social determinants of health (SDOH) affect vision loss, but it is unclear whether estimated associations differ between clinically evaluated and self-reported vision loss.ObjectiveTo identify associations between SDOH and evaluated vision impairment and to assess whether these associations hold when examining self-reported vision loss.Design, Setting, and ParticipantsThis population-based cross-sectional comparison included participants 12 years and older in the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES), participants of all ages (infants and older) in the 2019 American Community Survey (ACS), and adults 18 years and older in the 2019 Behavioral Risk Factor Surveillance System (BRFSS).ExposuresFive domains of SDOH that are based on Healthy People 2030: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.Main Outcomes and MeasuresPresenting vision impairment of 20/40 or worse in the better-seeing eye (NHANES) and self-reported blindness or serious difficulty seeing, even with glasses (ACS and BRFSS).ResultsOf 3 649 085 included participants, 1 873 893 were female (51.1%) and 2 504 206 were White (64.4%). SDOH across domains of economic stability, educational attainment, health care access and quality, neighborhood and built environment, and social context were significant predictors of poor vision. For example, higher income (poverty to income ratio [NHANES]: OR, 0.91; 95% CI, 0.85-0.98; [ACS]: OR, 0.93; 95% CI, 0.93-0.94; categorical income [BRFSS:Conclusions and RelevanceThe study team found evidence that associations between SDOH and vision impairment track together when using either clinically evaluated or self-reported vision loss. These findings support the use of self-reported vision data in a surveillance system to track trends in SDOH and vision health outcomes within subnational geographies.

Purpose To support survey validation efforts by comparing prevalence rates of self-reported and examination evaluated presenting visual impairment (VI) and blindness measured across national surveys. Design Cross-sectional comparison. Participants Participants in the 2016 American Community Survey, the 2016 Behavioral Risk Factor Surveillance System, the 2016 National Health Interview Survey, the 2005–2008 National Health and Nutrition Examination Survey (NHANES), and the 2016 National Survey of Children’s Health. Methods We estimated VI and blindness prevalence rates and confidence intervals for each survey measure and age group using the Clopper-Pearson method. We used inverse variance weighting to estimate the central tendency across measures by age-group, fitted trend lines to age-group estimates, and used the trend-line equations to estimate the number of United States persons with VI and blindness in 2016. We compared self-report estimates with those from NHANES physical evaluations of presenting VI and blindness. Main Outcome Measures Variability of prevalence estimates of VI and blindness. Results Self-report estimates of blindness varied between 0.1% and 5.6% for those younger than 65 years and from 0.6% to 16.6% for those 65 or older. Estimates of VI varied between 1.6% and 24.8% for those younger than 65 years and between 2.2% and 26.6% for those 65 years or older. For summarized survey results and NHANES physical evaluation, prevalence rates for VI increased significantly with increasing age group. Blindness prevalence increased significantly with increasing age group for summarized survey responses but not for NHANES physical examination. Based on extrapolations of NHANES physical examination data to all ages, we estimated that in 2016, 23.4 million persons in the United States (7.2%) had VI or blindness, an evaluated presenting visual acuity of 20/40 or worse in the better-seeing eye before correction. Based on weighted self-reported surveys, we estimated that 24.8 million persons (7.7%) had presenting VI or blindness. Conclusions Prevalence rates of VI and blindness obtained from national survey measures varied widely across surveys and age groups. Additional research is needed to validate the ability of survey self-report measures of VI and blindness to replicate results obtained through examination by an eye health professional.

Background: This study seeks to understand the general adult population's knowledge, attitudes, and stigma towards opioid use disorder (OUD), people with histories of opioid misuse, and policies related to OUD. Methods: We conducted a cross-sectional national survey of the U.S. adult population, using AmeriSpeak's® web, probability-based panel. The number of participants were 947 (493 females and 454 males) general population adults ages 19 -89 years old who completed a self-report survey covering: social stigma of OUD, opioid policy attitudes, perceptions of OUD as a crime, knowledge and beliefs about opioids and treatment, personal experience with opioids and the criminal justice (CJ) system, and demographics. Results: Thirteen percent self-reported ever misusing opioids, 3% reported an opioid overdose, and 14% reported personal experience with the CJ system. On average, the general adult population moderately endorses stigmatizing behaviors, agrees that OUD is a medical condition, agrees with policies to increase access to OUD treatment, and is less likely to endorse OUD as a crime. Having a disregard for OUD as a medical condition was most associated with higher levels of stigma, endorsing OUD as a crime, and disagreeing with policies to help people access OUD treatment. Conclusions: Our data provide guidance to policymakers concerning individuals with certain characteristics to target for public education efforts to reduce stigma and draw more support for public heath interventions for OUD. Our data also suggest that the content of this education should include improving understanding of OUD as a medical condition.

Key Points Question How many people in the US are living with uncorrectable visual acuity loss or blindness? Findings This bayesian meta-analysis generated an estimate that, in 2017, there were 7.08 million people living with visual acuity loss, of whom 1.08 million were living with blindness. Meaning Per this study, uncorrectable visual acuity loss and blindness are even larger drivers of health burden in the US than was previously known., This meta-analysis combines population-based surveys and data from the US Centers for Disease Control and Prevention’s Vision and Eye Health Surveillance System to produce estimates of visual acuity loss and blindness by age, sex, race/ethnicity, and US state., Importance Globally, more than 250 million people live with visual acuity loss or blindness, and people in the US fear losing vision more than memory, hearing, or speech. But it appears there are no recent empirical estimates of visual acuity loss or blindness for the US. Objective To produce estimates of visual acuity loss and blindness by age, sex, race/ethnicity, and US state. Data Sources Data from the American Community Survey (2017), National Health and Nutrition Examination Survey (1999-2008), and National Survey of Children’s Health (2017), as well as population-based studies (2000-2013), were included. Study Selection All relevant data from the US Centers for Disease Control and Prevention’s Vision and Eye Health Surveillance System were included. Data Extraction and Synthesis The prevalence of visual acuity loss or blindness was estimated, stratified when possible by factors including US state, age group, sex, race/ethnicity, and community-dwelling or group-quarters status. Data analysis occurred from March 2018 to March 2020. Main Outcomes or Measures The prevalence of visual acuity loss (defined as a best-corrected visual acuity greater than or equal to 0.3 logMAR) and blindness (defined as a logMAR of 1.0 or greater) in the better-seeing eye. Results For 2017, this meta-analysis generated an estimated US prevalence of 7.08 (95% uncertainty interval, 6.32-7.89) million people living with visual acuity loss, of whom 1.08 (95% uncertainty interval, 0.82-1.30) million people were living with blindness. Of this, 1.62 (95% uncertainty interval, 1.32-1.92) million persons with visual acuity loss are younger than 40 years, and 141 000 (95% uncertainty interval, 95 000-187 000) persons with blindness are younger than 40 years. Conclusions and Relevance This analysis of all available data with modern methods produced estimates substantially higher than those previously published.

To support survey validation efforts by comparing prevalence rates of self-reported and examination evaluated presenting visual impairment (VI) and blindness measured across national surveys.Cross-sectional comparison.Participants in the 2016 American Community Survey, the 2016 Behavioral Risk Factor Surveillance System, the 2016 National Health Interview Survey, the 2005-2008 National Health and Nutrition Examination Survey (NHANES), and the 2016 National Survey of Children's Health.We estimated VI and blindness prevalence rates and confidence intervals for each survey measure and age group using the Clopper-Pearson method. We used inverse variance weighting to estimate the central tendency across measures by age-group, fitted trend lines to age-group estimates, and used the trend-line equations to estimate the number of United States persons with VI and blindness in 2016. We compared self-report estimates with those from NHANES physical evaluations of presenting VI and blindness.Variability of prevalence estimates of VI and blindness.Self-report estimates of blindness varied between 0.1% and 5.6% for those younger than 65 years and from 0.6% to 16.6% for those 65 or older. Estimates of VI varied between 1.6% and 24.8% for those younger than 65 years and between 2.2% and 26.6% for those 65 years or older. For summarized survey results and NHANES physical evaluation, prevalence rates for VI increased significantly with increasing age group. Blindness prevalence increased significantly with increasing age group for summarized survey responses but not for NHANES physical examination. Based on extrapolations of NHANES physical examination data to all ages, we estimated that in 2016, 23.4 million persons in the United States (7.2%) had VI or blindness, an evaluated presenting visual acuity of 20/40 or worse in the better-seeing eye before correction. Based on weighted self-reported surveys, we estimated that 24.8 million persons (7.7%) had presenting VI or blindness.Prevalence rates of VI and blindness obtained from national survey measures varied widely across surveys and age groups. Additional research is needed to validate the ability of survey self-report measures of VI and blindness to replicate results obtained through examination by an eye health professional.