The Association of Smoking and Alcohol Use With Age-related Macular Degeneration in the Oldest Old: The Study of Osteoporotic Fractures
Accepted 18 July 2009. published online 01 October 2009.
Purpose
To estimate the incidence of age-related macular degeneration (AMD) and the association of smoking and alcohol in a population of older women.
Design
Prospective cohort study.
Methods
Subjects were women who attended the Study of Osteoporotic Fractures year-10 and year-15 follow-up clinic visits and had fundus photographs taken at both visits (n = 1958; 245 Black and 1713 White subjects; mean age at year 10 visit, 78.2 years). Forty-five degree stereoscopic fundus photographs were graded for AMD. Logistic regression was used to test whether risk factors were associated with incident AMD.
Results
The overall 5-year AMD incidence was 24.1% (95% confidence interval [CI], 21.7 to 26.6) for early and 5.7% (95% CI, 4.6 to 6.8) for late. Early AMD incidence in White subjects ranged from 21.9% in those aged 74 to 79 years to 33.2% in those 80 to 84 years, but was observed at the slightly lower rate of 29.0% in subjects ≥85 years (trend P < .0001). After confounder adjustment, alcohol consumption was significantly associated with an elevated risk of incident early AMD (odds ratio [OR], 1.57; 95% CI, 1.18 to 2.11). There was an increased risk of early AMD among subjects aged 80 years or older who were smoking compared to those younger than 80 years who were not smoking (OR, 5.49; 95% CI, 1.57 to 19.20; P for interaction = .026).
Conclusions
The magnitude of the greater-than-additive effect of smoking on the age-adjusted risk of AMD reinforces recommendations to quit smoking even for older individuals.
aDepartment of Ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, School of Public Health, UCLA, Los Angeles, California
bDepartment of Epidemiology, School of Public Health, UCLA, Los Angeles, California
cDepartment of Biostatistics, School of Public Health, UCLA, Los Angeles, California
dSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California
eDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
fVeterans Affairs Medical Center and Departments of Medicine and Epidemiology, University of Minnesota, Minneapolis, Minnesota
gDivision of Rheumatology, University of Maryland, Baltimore, Maryland
hKaiser Permanente Center for Health Research, Northwest/Hawaii, Portland, Oregon
iThe Retina-Vitreous Associates Medical Group, Beverly Hills, California
jDepartment of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
Inquiries to Anne L. Coleman, Jules Stein Eye Institute, 100 Stein Plaza, Los Angeles, CA 90095
ABSTRACT