McGuinness M B, Finger R P, Karahalios A, Guymer R H, English D R, Chong E W, Hodge A M, Robman L D, Giles G G, Simpson J A
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Eye (Lond). 2017 Sep;31(9):1345-1357. doi: 10.1038/eye.2017.139. Epub 2017 Aug 18.
AimsTo assess associations between features of age-related macular degeneration (AMD) and mortality.MethodsA total of 21 129 participants from the Melbourne Collaborative Cohort Study aged 47-85 years (60% female) were assessed for AMD (2003-2007). Mortality data to December 31, 2012 were obtained through linkage with the National Death Index. Associations were assessed using Cox regression, adjusting for age, sex, smoking, region of birth, education, physical activity, diet and alcohol.ResultsLate AMD was identified in 122 (0.6%) participants, including those with choroidal neovascularisation (n=55, 0.3%), geographic atrophy (n=87, 0.4%) and reticular pseudodrusen (n=87, 0.4%). After a median follow-up period of 8.1 years, 1669 (8%) participants had died, including those from cardiovascular diseases (386), tobacco-related cancers (179), and neurodegenerative disease (157). There was evidence of an increased rate of all-cause mortality for those with choroidal neovascularisation (Hazard Ratio (HR) 1.71 95% CI 1.06-2.76) and geographic atrophy (HR 1.46 95% CI 0.99-2.16). Choroidal neovascularisation was also associated with an increased rate of cardiovascular mortality (HR 3.16 95% CI 1.62-6.15) and geographic atrophy was associated with an increased rate of death from tobacco-related cancer (HR 2.86 95% CI 1.15-7.09). Weak evidence was also present for an association between choroidal neovascularisation and death from neurodegenerative disease (HR 2.49 95% CI 0.79-7.85). Neither reticular pseudodrusen nor the earlier stages of AMD were associated with mortality.ConclusionsLate AMD is associated with an increased rate of all-cause mortality. Choroidal neovascularisation and geographic atrophy were associated with death from cardiovascular disease and tobacco-related cancer, respectively.
评估年龄相关性黄斑变性（AMD）的特征与死亡率之间的关联。
对墨尔本协作队列研究中21129名年龄在47 - 85岁（60%为女性）的参与者进行AMD评估（2003 - 2007年）。通过与国家死亡指数联动获取截至2012年12月31日的死亡率数据。使用Cox回归评估关联，并对年龄、性别、吸烟、出生地、教育程度、身体活动、饮食和饮酒进行调整。
在122名（0.6%）参与者中发现了晚期AMD，包括脉络膜新生血管形成者（n = 55，0.3%）、地图样萎缩者（n = 87，0.4%）和网状假性玻璃膜疣者（n = 87，0.4%）。在中位随访期8.1年后，1669名（8%）参与者死亡，包括死于心血管疾病者（386例）、烟草相关癌症者（179例）和神经退行性疾病者（157例）。有证据表明，脉络膜新生血管形成者全因死亡率增加（风险比（HR）1.71，95%置信区间1.06 - 2.76），地图样萎缩者全因死亡率增加（HR 1.46，95%置信区间0.99 - 2.16）。脉络膜新生血管形成还与心血管死亡率增加相关（HR 3.16，95%置信区间1.62 - 6.15），地图样萎缩与烟草相关癌症死亡率增加相关（HR 2.86，95%置信区间1.15 - 7.09）。也有微弱证据表明脉络膜新生血管形成与神经退行性疾病死亡之间存在关联（HR 2.49，95%置信区间0.79 - 7.85）。网状假性玻璃膜疣和AMD的早期阶段均与死亡率无关。
晚期AMD与全因死亡率增加相关。脉络膜新生血管形成和地图样萎缩分别与心血管疾病死亡和烟草相关癌症死亡相关。
