Corresponding author: Geumseon LEE, PhD Department of Addiction Science, Graduate School, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 01795, Korea INTRODUCTION
Visually impaired individuals experience higher rates of chronic disease than those without disabilities. According to the 2020 national survey on persons with disabilities in Korea, the prevalence of hypertension among visually impaired individuals was 43.7%, nearly three times that in the general population (14.8%). Similarly, diabetes prevalence was more than double (25.0% vs. 9.7%) [1]. Such disparities cannot be explained by biological factors alone; they are likely influenced by restricted living environments, limited healthcare access, and unique health behaviors. Global surveillance reports, including World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) data, have consistently documented similar disparities in health outcomes among visually impaired populations [2-4]. Prior research has also confirmed that vision disorders is strongly associated with reduced healthcare utilization and delayed access to treatment, underscoring systemic barriers for visually impaired individuals [5]. In Korea, epidemiological studies have reported a notable prevalence of alcoholism and their health-related consequences [6].
Alcohol drinking is a well-established risk behavior associated with cardiovascular disease, diabetes, respiratory illness, and cancer. Epidemiological evidence has also shown that blindness is correlated with systemic diseases such as diabetes and renal dysfunction, highlighting the intersection of visual impairment and chronic illness [7]. However, previous research on people with disabilities has largely focused on general health behaviors, healthcare access, and quality of life, with few empirical studies specifically addressing the relationship between alcohol drinking and chronic diseases in visually impaired populations. U.S. data also indicate that adults with vision disorders face significant barriers to healthcare access and utilization [8]. Furthermore, problem drinking among people with disabilities has been shown to increase the risk of chronic diseases, underscoring the importance of targeted investigations [9].
This study therefore seeks to analyze the associations between alcohol drinking behaviors and chronic disease diagnoses among men with severe vision disorders aged 50 years or older, providing foundational evidence for developing tailored health promotion strategies. National reviews have emphasized the need for preventive policies focused on alcoholism in Korea, further supporting the rationale for this study [10]. Recent national statistics also highlight persistent health inequities among people with disabilities, reinforcing the urgency of evidence-based interventions [11-13]. This subgroup focus is further justified by evidence that older adults with both diabetes and vision disorders face heightened risks of malnutrition and chronic disease, highlighting the vulnerability of this population [14].
METHODS
Participants
This study included 237 men aged 50 years and older with severe vision disorders who were officially registered as persons with disabilities in Korea and held disability welfare card. Participants were recruited from the alumni associations member’s list of blind schools and vocational training centers for visually impaired nationwide. Also from the blind churches. We telephoned 450 visually impaired people, There were 46 cases (10.2%) where the phone ringtone was not received, 15 cases (3.3%) where the number did not exist or was changed to someone else’s name, and 32 cases (7.1) where the call was made but the person was under 50 years old or had mild vision disorders and thus did not meet the study criteria and 54 cases (12.0%) of them refused to participate in the survey, because the burden of the survey or recording, inconvenience to their family, or lack of time.
The minimum required sample size was calculated using G*Power software, assuming a medium effect size, α=0.05, and a 95% confidence level, resulting in 287 participants. To ensure sufficient power, the final target sample was set at 303.
This study was approved by the Institutional Review Board of Sahmyook University (IRB No. SYU 2023-02-015-002). Verbal informed consent was obtained from all participants by telephone prior to data collection, and the process was recorded. Confidentiality and anonymity were strictly maintained; no personally identifiable information was collected, and all analyses were performed on de-identified data.
Measures
Alcohol use
Measured using the Alcohol Use Disorders Identification Test–Korean version (AUDIT-K) [15,16]. The AUDIT-K has demonstrated good reliability and validity in Korean populations [16] and is also used in national addiction surveillance, ensuring comparability with current epidemiological data on alcohol use in Korea [12]. AUDIT-K was administered only to current drinkers, in accordance with the survey protocol of the Korea National Health and Nutrition Examination Survey (KNHANES).
Current drinkers
Current drinkers were those who responded “Yes” to the question, “Do you currently drink alcohol?”, and the AUDIT-K was administered only to this group.
Past drinkers
Past drinkers were those who answered “No” to the same question but reported a history of alcohol drinking.
Non-drinkers
Non-drinkers were participants who reported no history of alcohol use.
Information regarding the duration of abstinence or reasons for quitting (e.g., medical advice, health problems, or personal decision) was not available in the dataset.
Hazardous drinkers
Defined as those with an Alcohol Use Disorders Identification Test (AUDIT) score ≥8.
Chronic diseases
Chronic diseases were defined according to self-reported physician diagnoses, based on the standardized questionnaire of the Korea National Health and Nutrition Examination Survey. Participants were asked, “Have you ever been diagnosed with [disease] by a doctor?” and “When was your condition diagnosed?” Responses were used to classify whether a participant had ever been diagnosed with each condition. Accordingly, these variables represent lifetime prevalence rather than incidence or current disease status. Broad categories such as “liver disease” and “kidney disease” were used as defined in the KNHANES questionnaire without additional clinical criteria.
Statistical analysis
Analyses were conducted using SPSS version 28.0 (IBM Corp.). Descriptive and correlation analyses were performed, followed by logistic regression to examine associations between alcohol use and chronic disease diagnoses. Binary logistic regression was employed to evaluate the explanatory power of sociodemographic and health-related variables. Statistical significance was set at P <0.05, with Fisher’s exact tests applied when appropriate. Analyses were adjusted for age, body mass index (BMI), education level, economic activity, physical activity, regular diet habits, smoking.
RESULTS
Table 1 presents the general vision disorders included in the study. The mean age of participants was 66.2±8.76 years, and the mean BMI was 24.1±2.77 kg/m2. Most participants (75.1%) had an education level up to high school, and 65.8% reported having two or more chronic diseases. Regarding lifestyle behaviors, 40.1% engaged in excessive physical activity, while 37.6% showed insufficient levels. Nearly half of the participants (44.3%) reported poor eating habits, and 48.1% were classified as hazardous drinkers (AUDIT≥8). In addition, 21.9% were current smokers, and 52.3% were past smokers.
Fig. 1 presents the prevalence of chronic diseases among participants with vision disorders. The most common chronic condition was hypertension (22.8%), followed by liver disease (16.6%) and diabetes (16.2%). Arthritis (9.0%), pneumonia (8.4%), and kidney disease (8.2%) were also relatively prevalent. In contrast, heart disease (5.7%), cerebrovascular disease (5.7%), cancer (4.5%), and gout (3.1%) showed lower prevalence rates. Overall, hypertension, liver disease, and diabetes were the most frequently reported chronic conditions in this population.
Fig. 2 presents the overall burden of multimorbidity. Only 11.8% of participants reported no chronic conditions, while 22.4% had one and 28.3% had two. Multimorbidity (≥3 conditions) was observed in 37.6% of participants, with 7.2% reporting five or more conditions. These findings indicate that a substantial proportion of vision disorders men face complex challenges related to chronic disease management.
Logistic regression analyses were conducted to examine the association between current alcohol drinking and the prevalence of chronic diseases, using past drinkers/non-drinkers as the reference group. The odds ratios (ORs) and 95% confidence intervals (CIs) are presented in Table 2.
Compared with past drinkers/non-drinkers, current drinkers showed a significantly lower odds of heart disease (OR=0.16, 95% CI=0.04–0.59, P=0.006) and pneumonia (OR=0.28, 95% CI=0.11–0.75, P=0.011) showed significantly lower risks among current drinkers compared to past drinkers or non-drinkers. In contrast, arthritis (OR=3.08, 95% CI=1.06–8.96, P=0.039) showed a significantly higher risk among current drinkers.
Although cerebrovascular disease (OR=2.91, 95% CI=0.91–9.34, P=0.073) was not statistically significant, it tended to show an increased risk in current drinkers. Other diseases, including cancer, diabetes, liver disease, hypertension, kidney disease, and gout, did not show significant differences.
Among drinkers, the prevalence of chronic diseases was further compared between hazardous drinkers (AUDIT≥8) and non-hazardous drinkers (AUDIT<8). As shown in Table 3, hazardous drinkers had significantly higher prevalence of cancer (15.1% vs. 5.4%, P=0.023) and liver disease (43.4% vs. 28.6%, P=0.024).
Finally, Table 4 shows the association between the AUDIT risk groups and chronic diseases using binary logistic regression analysis adjusted for age, BMI, economic activity, physical activity, regular diet habits, and smoking status.
Among the diseases examined, only diabetes showed a statistically significant association with the high-risk drinking group (AUDIT≥16). Specifically, individuals with an AUDIT score ≥16 had a significantly higher odds of having diabetes (OR=9.00, 95% CI=1.68–48.14, P<0.05) compared to those with lower scores.
No significant associations were observed for other chronic diseases, including cancer, heart disease, liver disease, hypertension, kidney disease, gout, or osteoarthritis (P>0.05). Although cerebrovascular disease showed a relatively high OR (OR=12.25) in the high-risk drinking group, this result was not statistically significant due to the wide CI.
These findings suggest that heavy alcohol drinking, as indicated by higher AUDIT scores, may be strongly associated with an increased risk of diabetes, while its relationship with other chronic diseases remains inconclusive.
DISCUSSION
This study was conducted to examine the Associations of Alcohol Drinking with Chronic Diseases among Korean Men with Severe Vision Disorders. In this study, current drinkers showed a lower prevalence of heart disease and pneumonia compared to past or non-drinkers, whereas the prevalence of arthritis was higher. These findings are more likely to reflect reverse causality, resulting from changes in drinking habits after disease diagnosis, rather than a simple causal relationship. In particular, the lower ORs observed for heart disease and pneumonia may be due to individuals who quit or reduced drinking after being diagnosed with chronic diseases being categorized into the past/non-drinker group.
On the other hand, the approximately three-fold higher prevalence of arthritis among current drinkers suggests that alcohol drinking may act as an aggravating factor for inflammatory responses or certain conditions such as gouty arthritis [17].
No significant differences were found for other diseases such as liver disease, diabetes, or hypertension, which may be due to a combination of factors including limited sample size, diversity of drinking patterns, and behavioral changes following disease diagnosis. These findings suggest that alcohol drinking should be understood not as a direct cause of chronic diseases, but rather within the context of interactions between disease diagnosis and subsequent health behavior changes.
According to another study, past drinking among men with disabilities was associated with chronic diseases such as cerebrovascular and heart diseases [18], and similar results have been reported among elderly individuals with hypertension, where high-risk drinking was identified as a major factor contributing to health deterioration [12].
Past drinking experiences remain strong predictors of chronic diseases such as heart disease and chronic kidney disease, indicating accumulated health risks [19]. The apparent preventive effect of current drinking in this study may be related to behavioral changes following disease diagnosis [20], as individuals may have reduced or ceased alcohol drinking after being diagnosed with chronic conditions [21,22]. These findings highlight the long-term and cumulative impact of alcohol on chronic disease risk. The interpretation of the associations between past drinking and chronic diseases should consider the operational definition of past drinkers. In this study, past drinkers were defined as respondents who had consumed alcohol in the past but were not drinking at the time of the survey, without detailed information on the duration or cause of abstinence. Consequently, differences in the length or reason for quitting may have influenced the observed associations with specific chronic diseases such as heart or kidney disease.
This aligns with global evidence from the WHO and CDC, both of which identify alcohol as a major cause of non-communicable diseases [2-4]. Furthermore, these patterns suggest the possibility of reverse causality—where individuals reduce or stop drinking after being diagnosed with chronic diseases, either following medical advice or as part of self-directed health management. Similar trends have been observed in previous studies showing decreased alcohol drinking after diagnoses of cardiovascular disease, diabetes, or kidney disease. Data from the Korea Health Panel also confirmed this reverse causality, showing that adults reduced alcohol intake after being diagnosed with chronic diseases [13].
Consistent with national and international studies individuals with vision disorders demonstrate higher rates of hazardous drinking but lower participation in smoking cessation or alcohol reduction programs. Barriers such as limited access to health information, restricted opportunities for physical activity, and inadequate community resources contribute to structural health inequities. Evidence from the United States also supports these findings, showing that older adults with vision disorders have higher prevalence of chronic conditions and greater functional limitations compared with non-impaired peers [23]. Large-scale comparative studies have likewise reported that individuals with vision disorders have significantly higher prevalence of hypertension, heart disease, stroke, arthritis, and asthma [23]. Population-based analyses in Korea further demonstrated that people with vision disorders experience substantially higher rates of stroke, cardiovascular disease, hypertension, and diabetes than the general population [24]. These results emphasize that alcohol-related risks identified in this study must be understood within the broader context of chronic disease disparities associated with vision disorders. Additional analyses of older adults with diabetes have also shown that those who with vision disorders are at heightened risk of malnutrition and chronic disease complications [14].
This study underscores the importance of addressing alcohol use not only as an individual behavior but also within broader social and policy contexts. Expanding access to health promotion resources, enhancing preventive screening, and providing disability-inclusive healthcare environments are essential. Evidence suggests that disability support services can significantly improve healthcare utilization among people with disabilities, including those who with vision disorders [4]. Systematic reviews also indicate that tailored chronic disease interventions—such as accessible health education materials and integrated care programs—can reduce disparities and improve outcomes [25]. For visually impaired individuals, future interventions should include targeted alcohol prevention and education initiatives. These may involve Braille and audio materials, accessible mobile health applications, peer-support groups within disability communities, and collaboration with local welfare centers to ensure sustained participation. Such strategies would not only improve knowledge and awareness but also provide practical support for adopting and maintaining healthier behaviors. This approach is consistent with primary care–based interventions, where alcohol reduction programs embedded within broader lifestyle modifications have been shown to improve health outcomes [26].
Limitations of this study include reliance on self-reported chronic disease diagnoses, the cross-sectional design that precludes causal inference, the absence of a non-disabled control group and the restriction of the sample to men only. The focus on men reflected both their higher prevalence of chronic diseases in older age groups and the feasibility of recruitment through vocational training and welfare centers, but it limits the generalizability of findings to women with vision disorders. Furthermore, national surveillance reports continue to document persistent health inequities among people with disabilities in Korea, reinforcing the need for policy-level interventions [11-13]. Despite these limitations, this study contributes novel empirical evidence on the intersection of alcohol use and chronic diseases in a vulnerable population. Unlike earlier research that primarily addressed general health behaviors or healthcare access among people with disabilities, this study is the first to specifically analyze alcohol use patterns in relation to chronic disease diagnoses among older men with severe vision disorders, providing unique evidence to guide tailored public health interventions.
Summary
This study analyzed associations between alcohol drinking behaviors and chronic disease diagnoses among severe vision disorders men aged 50 years or older. Past drinkers/non-drinkers showed a significantly lower odds of heart disease and pneumonia. In contrast, arthritis showed a significantly higher risk among current drinkers. Hazardous drinkers (AUDIT-K score≥8) showed a higher prevalence of cancer and liver disease compared with non-hazardous drinkers. Hazardous drinking was associated with 9.00-fold increased risk of diabetes. These findings highlight the need for tailored alcohol reduction and health promotion interventions for individuals with vision disorders, emphasizing integrated approaches that extend beyond individual behavior to social and policy contexts.
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