Rehabilitation practices for burn survivors in low and middle income countries: A literature review.

OBJECTIVE: To systematically review the delivery and effectiveness of rehabilitation for burn survivors in low and middle income countries (LMIC). METHODS: We systematically searched the literature through 11 electronic databases and the reference lists of relevant studies. Studies were suitable for inclusion if they were primary research with a focus on burns rehabilitation in LMIC settings describing either service delivery or treatment effectiveness. No time, design or other limitations were applied, except English language. RESULTS: Of 226 studies identified, 17 were included in the final review, including 7 from India. The results were summarised in a narrative synthesis as the studies had substantial heterogeneity and small sample sizes, with many relying on retrospective data from non-representative samples with no control groups. Most studies (12) described service delivery and 5 examined the effectiveness of different types of rehabilitation. Multiple studies stressed the need for rehabilitation and multidisciplinary teams for burns management. CONCLUSIONS: The published research on burns rehabilitation is very limited and little is known about current practices in LMIC settings. In order to inform policy and service delivery, the effectiveness, feasibility and sustainability of current services needs to be investigated.

The psychological impact of traffic injuries sustained in a road crash by bicyclists: A prospective study.

OBJECTIVE: The objective of this study was to investigate the psychological impact of traffic injuries in bicyclists (cyclists) in comparison to car occupants who also sustained traffic injuries. Factors predictive of elevated psychological distress were also investigated. METHODS: An inception cohort prospective design was used. Participants included cyclists aged ≥17 years (mean age 41.7 years) who sustained a physical injury (n = 238) assessed within 28 days of the crash, following medical examination by a registered health care practitioner. Injury included musculoskeletal and soft tissue injuries and minor/moderate traumatic brain injury (TBI), excluding severe TBI, spinal cord injury, and severe multiple fractures. Assessment also occurred 6 months postinjury. Telephone-administered interviews assessed a suite of measures including sociodemographic, preinjury health and injury factors. Psychological impact was measured by pain catastrophization, trauma-related distress, and general psychological distress. The psychological health of the cyclists was compared to that of the car occupants (n = 234; mean age 43.1 years). A mixed model repeated measures analysis, adjusted for confounding factors, was used to determine differences between groups and regression analyses were used to determine contributors to psychological health in the cyclists 6 months postinjury. RESULTS: Cyclists had significantly better psychological health (e.g., lower pain catastrophizing, lower rates of probable posttraumatic stress disorder [PTSD], and lower general distress levels) compared to car occupants at baseline and 6 months postinjury. Factors predictive of cyclists' psychological distress included younger age, greater perceived danger of death, poorer preinjury health, and greater amount of time in hospital after the injury. CONCLUSIONS: These data provide insight into how cyclists perceive and adjust to their traffic injuries compared to drivers and passengers who sustain traffic injuries, as well as direction for preventing the development of severe psychological injury. Future research should examine the utility of predictors of psychological health to improve recovery.

Understanding novice driver policy agenda setting.

BACKGROUND: Despite the acute impact of road trauma involving novice drivers, there have been few efforts to identify the main factors influencing the novice driver policy agenda. Increasing the transparency of such policy dynamics may help inform future novice driver policy agenda-setting processes, as well as those in other public health settings. METHODS: Forty interviews were conducted between 2007 and 2009 with individuals involved in novice driver policy debates and processes in four Australian states. RESULTS: An increasing body of positive evaluations from other jurisdictions was seen to provide an initial stimulus for Australian novice driver policy activities. The dissemination of evidence by researchers, lobbying and advocacy by other influential stakeholders, and media reporting of multiple-fatality novice driver crashes were seen as other factors central to policy agenda setting. CONCLUSIONS: Australian graduated driver licensing (GDL) policy initiatives may only be acted upon once adequate political support is identified in terms of community demand for action and public acceptance of GDL policy in neighboring states. As such, researcher encouragement of community support for unpopular evidence-based policies during windows of opportunity for policy reform may act as an influential agenda-setting force.

Fatal crash trends for Australian young drivers 1997-2007: geographic and socioeconomic differentials.

BACKGROUND: Little has been published on changes in young driver fatality rates over time. This paper examines differences in Australian young driver fatality rates over the last decade, examining important risk factors including place of residence and socioeconomic status (SES). METHODS: Young driver (17-25years) police-recorded passenger vehicle crashes were extracted from New South Wales State records from 1997-2007. Rurality of residence and SES were classified into three levels based on drivers' residential postcode: urban, regional, or rural; and high, moderate, or low SES areas. Geographic and SES disparities in trends of fatality rates were examined by the generalized linear model. Chi-square trend test was used to examine the distributions of posted speed limits, drinking driving, fatigue, seatbelt use, vehicle age, night-time driving, and the time from crash to death across rurality and socioeconomic status. RESULTS: Young driver fatality rate significantly decreased 5% per year (p<0.05); however, stratified analyses (by rurality and by SES) showed that only the reduction among urban drivers was significant (average 5% decrease per year, p<0.01). The higher relative risk of fatality for rural versus urban drivers, and for drivers of low versus high SES remained unchanged over the last decade. High posted speed limits, fatigue, drink driving and seatbelt non-use were significantly associated with rural fatalities, whereas high posted speed limit, fatigue, and driving an older vehicle were significantly related to low SES fatality. CONCLUSION: The constant geographic and SES disparities in young driver fatality rates highlight safety inequities for those living in rural areas and those of low SES. Better targeted interventions are needed, including attention to behavioral risk factors and vehicle age.

Media framing of graduated licensing policy debates.

BACKGROUND: The overrepresentation of young drivers in road trauma statistics produces significant media interest. Graduated licensing restrictions involving night-time curfews and restrictions on passenger numbers are prominent topics within media coverage. This was particularly apparent in Australia between January 2004 and July 2008, when various models of either restriction were introduced in four states. METHODS: Australian newspaper and Sydney free-to-air television coverage during the peak period were analysed to identify the framing strategies used by news actors supporting or opposing these policies. RESULTS: Fifteen frames were identified. These predominantly assessed the proposed restrictions in terms of their need, evidence base, practicality and the degree to which they were consonant with 'commonsense' perceptions and had community support. While expert road injury reduction news actors primarily emphasised their moral imperative and likely effectiveness, opponents stressed their impracticality and proposed alternative solutions. CONCLUSIONS: Research evidence is only one component of information presented as policy-relevant in policy discourse conducted in news media. Policy reform advocates using the media to advocate for evidence-based policies in road injury prevention need to appreciate that evidence is not the only currency exchanged in such debates and should study opponents' rhetoric in order to anticipate and counteract the framing strategies being used.

Road crash trends for young drivers in New South Wales, Australia, from 1997 to 2007.

OBJECTIVES: The objective of this article was to explore overall crash and injury trends over the past decade for young drivers residing in New South Wales (NSW), Australia, including gender and age disparities. METHODS: Passenger vehicle crashes for drivers aged 17-25 occurring during 1997-2007 were extracted from the state crash database to calculate crash rates (per licensed driver). Generalized linear models were used to examine crash trends over time by severity of driver injury, adjusting for age, gender, rurality of residence, and socioeconomic status. Yearly adjusted relative risks of crash by gender and by age group were also examined over the study period. RESULTS: Young driver noninjury and fatality rates significantly decreased by an average of 4 percent (95% CI: 4-5) and 5 percent (95% CI: 0-9) respectively each year from 1997 to 2007. Young driver injury rates significantly increased by about 12 percent (95% CI: 9-14) to the year 2001 and then significantly decreased. The relative risk of crash (regardless of driver injury) for males compared to females significantly decreased over time. Compared to drivers aged 21-25, drivers aged 17 and particularly 18- to 20-year-olds had significantly and consistently higher crash risks across the study period. CONCLUSIONS: Overall, there has been a significant decline in young driver crashes in NSW over the last decade. Regardless of injury severity, males' risk of crash has reduced more than female young drivers, but drivers aged 17 continue to be at higher risk. These findings provide feedback on potential road safety successes and areas needing specific interventions for future improvements.

Socioeconomic status and risk of car crash injury, independent of place of residence and driving exposure: results from the DRIVE Study.

BACKGROUND: Previous studies that found increased crash risks for young drivers of low socioeconomic status (SES) have failed to adjust for factors such as driving exposure and rural residence. This aim of this study is to examine the independent effect of SES on crash risk, adjusting for such factors, and to examine the relationship between injury severity following a crash and SES. METHODS: Information on risk factors for crash collected from 20,822 newly licenced drivers aged 17-24 years in New South Wales, Australia, as part of the DRIVE Study was prospectively linked to hospitalisation data. SES was classified as high, moderate or low based on the Australia 2001 Socio-Economic Index for Areas. Poisson regression was used to model risk of crash-related hospitalisation by SES, adjusting for confounders. Two measures of injury severity--urgency of treatment and length of hospital stay--were examined by SES. RESULTS: Results of multivariable analysis showed that drivers from low SES areas had increased relative risk (RR 1.8, 95% CI 1.1 to 3.1) of crash-related hospitalisation compared to drivers from high SES areas. This increased risk remained when adjusting for confounders including driving exposure and rurality (RR 1.9, 95% CI 1.1 to 3.2). No significant association was found between injury severity and SES. CONCLUSION: The higher risk of crash-related hospitalisation for young drivers from low SES areas is independent of driving exposure and rural-urban differences. This finding may help improve and better target interventions for youth of low SES.

Risk and type of crash among young drivers by rurality of residence: findings from the DRIVE Study.

BACKGROUND: Most previous literature on urban/rural differences in road crashes has a primary focus on severe injuries or deaths, which may be largely explained by variations of medical resources. Little has been reported on police-reported crashes by geographical location, or crash type and severity, especially among young drivers. METHODS: DRIVE is a prospective cohort study of 20,822 drivers aged 17-24 in NSW, Australia. Information on risk factors was collected via online questionnaire and subsequently linked to police-reported crashes. Poisson regression was used to analyse risk of various crash types by three levels of rurality of residence: urban, regional (country towns and surrounds) and rural. RESULTS: Compared to urban drivers, risk of crash decreased with increasing rurality (regional adjusted RR: 0.7, 95% CI 0.6-0.9; rural adjusted RR: 0.5, 95% CI 0.3-0.7). Among those who crashed, risk of injurious crash did not differ by geographic location; however, regional and rural drivers had significantly higher risk of a single versus multiple vehicle crash (regional adjusted RR 1.8, 95% CI 1.3-2.5; rural adjusted RR: 2.0, 95% CI 1.1-3.6), which was explained by speeding involvement and road alignment at the time or site of crash. CONCLUSIONS: Although young urban drivers have a higher crash risk overall, rural and regional residents have increased risk of a single vehicle crash. Interventions to reduce single vehicle crashes should aim to address key issues affecting such crashes, including speeding and specific aspects of road geometry.

The burden of fatal and non-fatal injury in rural India.

BACKGROUND: Little is known about the burden or causes of injury in rural villages in India. OBJECTIVE: To examine injury-related mortality and morbidity in villages in the state of Andhra Pradesh, India. METHODS: A verbal-autopsy-based mortality surveillance study was used to collect mortality data on all ages from residents in 45 villages in 2003-2004. In early 2005, a morbidity survey in adults was carried out using stratified random sampling in 20 villages. Participants were asked about injuries sustained in the preceding 12 months. Both fatal and non-fatal injuries were coded using classification methods derived from ICD-10. RESULTS: Response rates for the mortality surveillance and morbidity survey were 98% and 81%, respectively. Injury was the second leading cause of death for all ages, responsible for 13% (95% CI 11% to 15%) of all deaths. The leading causes of fatal injury were self-harm (36%), falls (20%), and road traffic crashes (13%). Non-fatal injury was reported by 6.7% of survey participants, with the leading causes of injury being falls (38%), road traffic crashes (25%), and mechanical forces (16.1%). Falls were more common in women, with most (72.3%) attributable to slipping and tripping. Road traffic injuries were sustained mainly by men and were primarily the result of motorcycle crashes (48.8%). DISCUSSION: Injury is an important contributor to disease burden in rural India. The leading causes of injury-falls, road traffic crashes, and suicides-are all preventable. It is important that effective interventions are developed and implemented to minimize the impact of injury in this region.

A cohort study of 20,822 young drivers: the DRIVE study methods and population.

BACKGROUND AND OBJECTIVE: Research on young drivers directly linking risk factors to serious injury and death outcomes is required. The DRIVE Study was established to facilitate this aim. This paper outlines the study methods and describes the population that has been recruited, in order to demonstrate that the necessary heterogeneity in risk factors has been attained. DESIGN, SETTING AND PARTICIPANTS: Drivers aged 17-24 years holding their first-stage provisional driver's licence from New South Wales, Australia, were recruited into a prospective cohort study. The participants were contacted by mail and asked to complete the study questionnaire at an online site or via a mailed questionnaire. Baseline data collection involved a questionnaire with questions to drivers about their training, risk perception, driver behavior, sensation-seeking behavior and mental health. Participants gave consent for prospective data linkage to their data on licensing, crashes and injuries, held in routinely collected databases. RESULTS: 20 822 drivers completed the baseline questionnaire, of whom 45.4% were men, 74.3% resided in capital cities and 25.7% in regional or remote areas. The recruited study population showed a wide variation in the risk factors under examination. For example, almost 40% of drivers reported drinking alcohol at hazardous levels and about 32% of participants seemed to be at a high or very high risk of psychological distress. Participants reported a mean of 67.3 h (median 60 h) of supervised driver training while holding their learner's permit. CONCLUSIONS: The DRIVE Study has a robust study design aimed at minimizing bias in the collection of outcome data. Analyses of baseline data showed substantial heterogeneity of risk factors in the study population. Subsequent prospective linkages comparing relative differences in exposures at baseline with the outcomes of interest have the potential to provide important new information needed to develop targeted interventions aimed at young drivers.

Prevalence of helmet use among motorcycle riders in Vietnam.

OBJECTIVES: To investigate the rate of helmet use among motorcycle drivers in Hai Duong province of Vietnam during winter/spring 2005, and to compare the rates of helmet use by road types. METHOD: Population-based observational surveys. RESULTS: 16,560 motorcyclists were observed across 37 road sites (incorporating 5 road categories). The overall weighted average of helmet use for motorcyclists was 29.94%, with male drivers more likely to wear helmets than female drivers (odds ratio (OR) 1.64, 95% confidence interval (CI) 1.53 to 1.76). Male pillion passengers were less likely to wear helmets than female pillion passengers (OR 0.78, 95% CI 0.72 to 0.85). The number of adult drivers using helmets is larger as compared with that of young drivers (OR 8.56, 95% CI 5.93 to 12.19). The rates of helmet use were significantly higher (p<0.001) on compulsory roads and were 59.01%, 39.97%, 24.22%, 12.7% and 9.54% for national, provincial, district, commune and Hai Duong inner-city roads, respectively. CONCLUSION: Helmet legislation has increased the rate of helmet use by motorcycle drivers on compulsory roads. Elsewhere, rate of helmet use is very low, indicating that in the absence of legislation and enforcement, motorcyclists in Vietnam will not wear a helmet.

"Banned from the streets I have paid to use": an analysis of Australian print media coverage of proposals for passenger and night driving restrictions for young drivers.

OBJECTIVE: To catalogue arguments that can be anticipated in public debate when passenger and night driving restrictions are being advocated. DESIGN AND SETTING: Frame analysis of all relevant coverage of these topics in Australian print media during the three month period between June and September 2004 when intensive debate on the topic occurred. MAIN OUTCOME MEASURES: Debating frames used in reports and commentary on passenger and night driving restrictions. RESULTS: There were 52 relevant articles published containing seven distinct frames supporting the restrictions and six opposing them. Overall, more instances of frames supporting the restrictions were published; these mostly focused on the potential for saving lives. Opposition to the restrictions focused largely on their inappropriateness as a road safety measure as well as on the importance of young people's autonomy and freedom. CONCLUSIONS: Advocates of passenger and night driving restrictions have a number of arguments available to advance their case; however, it is important to anticipate and address possible counter arguments. Future research should address the saliency of different arguments to the public and key decision makers in government.

Vehicle year and the risk of car crash injury.

OBJECTIVE: To quantify the association between vehicle age and risk of car crash injury. DESIGN AND SETTING: Data from a population based case-control study conducted in the Auckland region in 1998/99 was used to examine the adjusted risk of car crash injury or death due to vehicle age, after controlling for a range of known confounders. Cases were all cars involved in crashes in which at least one occupant was hospitalized or killed anywhere in the Auckland region, and controls were randomly selected cars on Auckland roads. The drivers of the 571 case vehicles and 588 control vehicles completed a structured interview. MAIN OUTCOME MEASURE: Hospitalisation or death of a vehicle occupant due to car crash injury. RESULTS: Vehicles constructed before 1984 had significantly greater chance of being involved in an injury crash than those constructed after 1994 (odds ratio 2.88, 95% confidence interval (CI) 1.20 to 6.91), after adjustment for potential confounders. There was also a trend for increasing crash risk with each one year increase in vehicle age after adjustment for potential confounders (odds ratio 1.05, 95% CI 0.99 to 1.11; p = 0.09). CONCLUSION: This study quantifies the increased risk of car crash injury associated with older vehicle year and confirms this as an important public health issue.

Risk factors for fractures of the wrist, shoulder and ankle: the Blue Mountains Eye Study.

Few studies have examined risk factors for fractures of the wrist, shoulder or ankle. The Blue Mountains Eye Study is a population-based longitudinal study in 3654 people aged 49 years or older resident in an area west of Sydney, Australia. Detailed eye examinations and interviews were carried out at baseline (1992-3) and after 5 years (1997-9). Information about fractures sustained during follow-up were collected by a combination of self-report and a search of hospital radiology records. After 4.7 years follow-up subjects had sustained 53 fractures of the distal forearm, 20 fractures of the proximal humerus and 33 ankle fractures. In multivariate models factors independently associated with wrist fractures in women were no vigorous exercise in the past 2 weeks (relative risk RR 0.4, 95% CI 0.2-0.9) and ever use of HRT (RR 0.4, 95% CI 0.1-1.0). Factors independently associated with ankle fractures were male sex (RR 0.3, 95% CI 0.1-0.8) and visual field loss (RR 2.8, 95% CI 1.2-6.6). These findings are in keeping with other studies, and suggest that different types of osteoporotic fracture have different, if overlapping, sets of risk factors.

Diabetes and risk of fracture: The Blue Mountains Eye Study.

OBJECTIVE: To examine associations between measures of diabetes and risk of fracture in a population-based sample of older Australians. RESEARCH DESIGN AND METHODS: This was a prospective study of 3,654 subjects aged 49 years and older who were residents in the Blue Mountains, west of Sydney, Australia. At baseline, subjects were asked questions about history and treatment of diabetes, and fasting blood samples were taken. Photographs were taken of the retina and lens to grade retinopathy and cataract. Details of fractures (excluding rib and vertebral fractures) were collected by a combination of self-report and medical record searches; all fractures were radiologically confirmed. RESULTS: After 2 years of follow-up, we found that several diabetes-related factors were significantly associated (in multivariate models) with increased risk of all fractures combined, including presence of diabetic retinopathy (adjusted RR 5.4, 95% CI 2.7-10.8), diabetes duration > or = 10 years (3.3, 1.3-8.2), cortical cataract involving > or = 25% of the lens area (2.5, 1.3-4.7), and insulin treatment (5.9, 2.6-13.5). The proximal humerus was the only individual fracture site associated with diabetes. Diabetic retinopathy (10.3, 2.2-48.0), diabetes duration (for > or = 10 years duration; 11.4, 2.4-54.2), and insulin treatment (18.8, 4.0-88.7) were all associated with proximal humerus fracture. CONCLUSIONS: These data suggest a significantly increased risk of fracture associated with diabetic retinopathy, advanced cortical cataract, longer diabetes duration, and insulin treatment. However, there are some shortcomings in this study that may limit these findings.

Sensitivity and specificity of tests to detect eye disease in an older population.

OBJECTIVE: To compare the ability of tests of visual function to detect the presence of eye disease. DESIGN: Cross-sectional study. PARTICIPANTS: Three thousand six hundred fifty-four of 4433 (82.4%) eligible residents of an area near Sydney aged 49 years and older had a detailed eye examination, including retinal and lens photography and subsequent grading of eye disease, tests of presenting and corrected visual acuity, contrast sensitivity, screening visual field and intraocular pressure. MAIN OUTCOME MEASURES: Receiver operator characteristic (ROC) curves were created and area under the curve compared for each vision test. Sensitivity and specificity were calculated for each test. RESULTS: No single vision test predicted the presence of eye disease with any consistency. Best-corrected visual acuity or contrast sensitivity had the highest area under the ROC curve for most eye diseases examined but had poor sensitivity and specificity. For glaucoma and diabetic retinopathy there was no difference in area under the curve for any of the tests examined, and no test had a good balance of sensitivity and specificity. Screening tests (performed with presenting correction) did not perform as well as nonscreening tests (those carried out after refraction with best correction). CONCLUSIONS: Current vision tests are not particularly good at detecting eye disease compared with the "gold standard" of a full eye examination performed by an ophthalmologist. Further work in this area should be carried out before vision screening programs can be recommended for implementation among older people.

Visual impairment and risk of hip fracture.

As part of a case-control study, the Auckland Hip Fracture Study (1991-1994), the authors examined associations between impaired vision and risk of hip fracture. Subjects (911 cases and 910 controls aged 60 years or older) completed a questionnaire and had vision measurements taken, including measurements of visual acuity and stereopsis (depth perception). Binocular visual acuity worse than 20/60 was statistically significantly associated with increased risk of hip fracture after adjustment for age, sex, proxy response, hours of activity per week, and height (odds ratio (OR) = 1.5; 95% confidence interval (CI): 1.1, 2.0), as was having poor vision (less than 20/100) in both eyes (OR = 2.4; 95% CI: 1.0, 6.1). Having no depth perception was associated with increased risk (OR = 6.0 95% CI: 3.2, 11.1), as were categories of decreasing stereopsis (trend p = 0.0001), self-reported poor vision (OR = 1.4; 95% CI: 1.0, 1.9), not wearing glasses at the time of the fall (OR = 1.2; 95% CI: 1.0, 1.6), and increasing time since the last eye examination (trend p = 0.03). The population attributable risk of hip fracture due to poor visual acuity or stereopsis was 40%. Visual factors are important fall-related factors which influence risk of hip fracture. Risk of hip fracture may be decreased by correcting refractive error, improving stereopsis, and administering regular eye examinations.

Visual function tests, eye disease and symptoms of visual disability: a population-based assessment.

PURPOSE: To examine associations between eye disease and tests of visual function with self-reported visual disability. METHODS: The Blue Mountains Eye Study is a cross-sectional census-based survey of eye disease in two postcode areas in the Blue Mountains, west of Sydney, Australia. Of 4433 eligible residents, 3654 (82,4%) participated. Subjects had a detailed eye examination, including tests of visual acuity, contrast sensitivity, disability glare and visual field. Lens and retinal photographs were taken and graded according to standardized protocols for presence of cataract, early and late age-related maculopathy, glaucoma, diabetic retinopathy, retinal vein occlusion and other eye diseases. An interviewer-administered questionnaire included questions about perception of visual disability. RESULTS: Scores on all tests of visual function significantly decreased with age (P < 0.0001). This decrease persisted for all tests except disability glare after excluding subjects with identifiable eye disease. The presence of one or more eye diseases was significantly associated with all (self-reported) measures of visual disability (trouble driving at night, difficulty recognizing a friend across the street, reading a newspaper or recognizing detail on televsion): mixed cataract (cortical and nuclear, or posterior subcapsular and nuclear) was associated with trouble driving at night and difficulty recognizing a friend across the street. A 10-letter (two-line) decrease in best corrected or presenting visual acuity was significantly associated with all self-reported measures of vsual dsability, as was a two-step decrease in contrast sensitvity. A five-point increase in points missing in the visual field was weakly but significantly associated with all self-reported measures of visual disability except trouble driving at night. CONCLUSIONS: Visual function declines with age. Impaired visual function was strongly, and eye disease relatively weakly associated with reports of visual disability.

Refractive errors in an older population: the Blue Mountains Eye Study.

OBJECTIVE: To determine prevalence and associations with refractive errors in a defined older population. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 3654 residents, aged 49-97, of the Blue Mountains, west of Sydney, Australia. METHODS: Comprehensive questionnaire and detailed eye examination, including refraction. MAIN OUTCOME MEASURES: Refractive error of phakic eyes, age, gender, and education. RESULTS: Prevalence rates were determined for myopia (15%), hyperopia (57%), and emmetropia (28%). Hyperopia prevalence was age-related, increasing from 36% in persons aged <60 years to 71 % of persons aged > or = 80 (P < 0.0001), whereas myopia prevalence decreased with age, from 21 % in persons aged <60 years to 10% of persons aged > or = 80 years (P < 0.0001). Younger myopic subjects in this population reported first wearing distance correction at a significantly younger age than older subjects, P < 0.0001. After adjustment for age, women were slightly more hyperopic (mean +0.75 diopters [D]) than men (mean +0.59 D, P = 0.0012. The gender-adjusted mean spherical error increased with age from +0.03 D in persons aged <60 years to +1.2 D in persons aged > or = 80 years (P < 0.0001). The gender-adjusted mean cylinder power also increased with age, from -0.6 D in persons aged <60 years to -1.2 D in persons aged > or = 80 years (P < 0.0001). The mean axis of astigmatism was "against the rule" in all age groups. Anisometropia increased with age, from a mean of 0.4 D in persons aged <60 to 0.9 D in persons aged > or = 80 years (P < 0.0001). Higher education was associated with myopia in men (P = 0.009) but not in women (P = 0.21) after adjustment for age. CONCLUSION: This report has documented the detailed refractive status of an older population, confirming previously described trends but also finding an apparent higher prevalence of myopia among younger members of this community.