Purpose To estimate dry eye prevalence in the Beaver Dam Offspring Study (BOSS), including a young adult population, and investigate associated risk factors and impact on health-related quality of life. Design Cohort study. Methods The BOSS (2005–2008) is a study of aging in the adult offspring of the population-based Epidemiology of Hearing Loss Study cohort. Questionnaire data on health history, medication use, risk factors, and quality of life were available for 3275 participants. Dry eye was determined by self-report of frequency of symptoms and the intensity of those symptoms. Associations between dry eye and risk factors were analyzed using logistic regression. Results The prevalence of dry eye in the BOSS was 14.5%, 17.9% of women and 10.5% of men. In a multivariate model, statistically significant associations were found with female sex (Odds Ratio (OR), 1.68; 95% Confidence Interval (CI), 1.33–2.11), current contact lens use (OR, 2.01; 95%CI, 1.53–2.64), allergies (OR, 1.59; 95%CI 1.22–2.08), arthritis (OR, 1.44; 95%CI, 1.12–1.85), thyroid disease (OR, 1.43; 95%CI, 1.02–1.99), antihistamine use (OR, 1.54; 95%CI, 1.18–2.02), and steroid use (OR, 1.54; 95%CI, 1.16–2.06). Dry eye was also associated with lower scores on the Medical Outcomes Short Form-36 (β=−3.9, p<0.0001) as well as on the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) (β= −3.4, p<0.0001) when controlling for age, sex, and comorbid conditions. Conclusions The prevalence of dry eye and its associated risk factors in the BOSS were similar to previous studies. In this study, DES was associated with lower quality of life on a health-related quality of life instrument and the vision-specific NEI-VFQ-25.

Six commonly used HRQoL indexes and two of three health status summary measures indicated lower HRQoL with obesity and overweight than with normal BMI, but the degree of decrement varied by index. The association appeared driven primarily by physical health, although mental health also played a role among women. Counter to hypotheses, blacks may have highest HRQoL when overweight.

Background Sensorineural impairments and cardiovascular risk factors (CVRF) and disease (CVD) in midlife may be important predictors of future cognitive health, but longitudinal studies that include multiple sensorineural measures in middle-aged adults are lacking. Methods Hearing, vision, and olfaction, and CVRF and CVD were measured at the Beaver Dam Offspring Study baseline (2005–2008) examination. The Mini-Mental State Examination and Trail Making Tests A and B were administered at all phases and additional cognitive function measures were obtained at 5 (2010–2013) and 10 years (2015–2017). Cox proportional hazards models were used to evaluate associations between baseline sensorineural impairments, CVRF, CVD, and 10-year cumulative incidence of cognitive impairment and decline. Results There were 2,556 participants (22–84 years) without cognitive impairment at baseline and data from at least one follow-up. In a multivariable model including age, sex, education, and head injury, visual impairment (hazard ratio = 2.59, 95% confidence interval = 1.34, 5.02), olfactory impairment (hazard ratio = 3.18, 95% confidence interval = 1.53, 6.59), CVD (hazard ratio = 2.37, 95% confidence interval = 1.24, 4.52), and not consuming alcohol in the past year (hazard ratio = 2.21, 95% confidence interval = 1.16, 4.19) were associated with the 10-year cumulative incidence of cognitive impairment. Current smoking and diabetes were associated with increased risk, and exercise with decreased risk, of 10-year decline in cognitive function. Conclusions Visual and olfactory impairments, CVRF, and CVD were associated with the 10-year cumulative incidence of cognitive impairment and decline in middle-aged adults. Identifying modifiable factors associated with cognitive decline and impairment in midlife may provide opportunities for prevention or treatment and improve cognitive health later in life.

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Importance Contrast sensitivity (CS) is an important indicator of visual function that impacts daily life, including mobility, visually intensive tasks, safety, and autonomy. Understanding risk factors for CS impairment could lead to prevention of decreases in visual function. Objective Determine the incidence of CS impairment in a large cohort, and investigate factors potentially associated with incidence, including cadmium (Cd) and lead (Pb) levels. Design The Beaver Dam Offspring Study (BOSS, baseline 2005–2008) was conducted in the adult children of the participants of the population-based Epidemiology of Hearing Loss Study. Follow-up examinations occurred in 2010–2013 and 2015–2017. Setting Longitudinal cohort study Participants 1983 participants free of CS impairment at baseline. Particpants were primarily non-hispanic white, 51.8% women, mean age 48 years (standard deviation=9.3). Main Outcome CS was measured using Pelli-Robson Letter Sensitivity Charts, and incident impairment was defined as a log CS score less than 1.55 in either eye at any follow-up examination. Cd and Pb levels were measured in whole blood, using inductively coupled plasma mass spectrometry. Associations between baseline characteristics and CS impairment incidence were examined using Cox proportional hazard models and quantified as hazard ratios (HR) with 95% confidence intervals (CI). Results The 10-year cumulative incidence of CS impairment was 24.8%, was similar in women and men, and was highest in the oldest age group (64–84 years) at 66.3%. In multivariable models, a Cd level in the highest quintile (Q5 vs. Q1–4) (HR=1.35, CI=1.02, 1.78), age (per 5 years) (HR=1.34, CI=1.25,1.44), waist circumference (per 5 cm) (HR=1.06, CI=1.02,1.10), and number of plaque sites (1–3 vs. 0, HR=1.37, CI=1.03,1.81; 4–6 vs. 0, HR=2.63, CI=1.26,5.48) were associated with increased risk, while male sex (HR=0.77, CI=0.60,0.98) and any alcohol consumption (vs. none, HR=0.54, CI=0.39, 0.76) were associated with decreased risk. Results were similar when smoking status replaced Cd in the models. Lead level was not associated with increased risk. Conclusions and Relevance Incident CS impairment was common in the 10-year follow-up. Cd, but not Pb, was associated with increased risk. Other modifiable risk factors were associated with risk implying that changes in behavior could reduce future incident impairment.

Objectives/Hypothesis: To determine the 10-year incidence of hearing impairment (HI) and associated risk factors in the Beaver Dam Offspring Study (BOSS; 2004-present), a large middle-aged cohort followed for 10 years. ) follow-up examinations. HI was defined as a pure-tone average >25 dB HL in either ear. BOSS participants free of HI at baseline with at least one follow-up examination (N = 2,065) were included. Potential risk factors evaluated included cardiovascular measures, health history, lifestyle factors, inflammatory markers, vitamins D and B12, lead, and cadmium.Results: Participants were 21 to 79 years (mean age = 47.9 years) at baseline. The 10-year cumulative HI incidence was 17.4% (95% confidence interval [CI]: 15.7-19.2) and was twice as likely in men (24.4%, 95% CI: 21.5-27.7) than in women (12.2%, 95% CI: 10.3-14.3). In a multivariable adjusted model, age (hazard ratio [HR] = 1.48, 95% CI: 1.38-1.59, per 5 years), male sex (HR = 2.47, 95% CI: 1.91-3.18), less than a college education (HR = 1.35, 95% CI: 1.02-1.79), body mass index (HR = 1.03, 95% CI: 1.01-1.05, per kg/m 2 ), and higher cadmium levels (HR = 1.42, 95% CI: 1.05-1.92, quintile 5 vs. quintiles 1-4) were associated with the 10-year cumulative incidence of HI. There was no association between high lead levels, vitamins D or B12, and 10-year incidence of HI.Conclusions: In addition to age and sex, obesity, education, and blood cadmium levels were associated with increased incidence of HI. These prospective results add to evidence that age-related HI is a multifactorial preventable disorder.

Reduced kidney function as estimated using cystatin C, but not cystatin C alone, was associated with the 20-year cumulative incidence of HI, suggesting that some age-related HI may occur in conjunction with or as the result of reduced kidney function.

Background Neurodegenerative diseases are public health challenges in aging populations. Early identification of people at risk for neurodegeneration might improve targeted treatment. Noninvasive, inexpensive screening tools are lacking but are of great potential. Optical coherence tomography (OCT) measures the thickness of nerve cell layers in the retina, which is an anatomical extension of the brain and might be indicative of common underlying neurodegeneration. We aimed to determine the association of macular ganglion cell-inner plexiform layer (mGCIPL) thickness with cognitive and sensorineural function in midlife. Method This cross-sectional study included 1,880 Beaver Dam Offspring Study participants (aged 27–93 years, mean 58) who participated in the 10-year follow-up examination. We assessed cognitive function and impairment, hearing sensitivity thresholds and impairment, central auditory processing, visual impairment, and olfactory impairment. We measured mGCIPL using the Cirrus 5000 HD-OCT Macular Cube Scan. Multivariable linear and logistic regression models adjusted for potential confounders were used to determine associations between mGCIPL thickness and cognitive and sensorineural functions, as well as for comparing participants with a thin mGCIPL (1 SD below average) to the remainder in those functions. Results Thinner mGCIPL was associated with worse cognitive function, worse central auditory function, and visual impairment. We found an association of mGCIPL thickness with hearing sensitivity in women only and no association with impairment in hearing, olfaction, and cognition. Results on the thin group comparisons were consistent. Conclusions mGCIPL thickness is associated with cognitive and sensorineural function and has the potential as a marker for neurodegeneration in middle-aged adults.