Medicine Service, VA Medical Center, Birmingham, Alabama, United States of America.
Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama, United States of America.
PLoS One. 2018 Jul 12;13(7):e0199562. doi: 10.1371/journal.pone.0199562. eCollection 2018.
To assess whether gout is associated with incident age-related macular degeneration (AMD).
We used the 5% Medicare claims data from 2006-12 for all beneficiaries who were enrolled in Medicare fee-for-service (Parts A, B) and not enrolled in a Medicare Advantage Plan, and resided in the U.S. People were censored at the occurrence of new diagnosis of AMD, death or the end of study (12/31/2012), whichever occurred first. We used multivariable-adjusted Cox regression analyses to assess the association of gout with incident AMD, adjusted for demographics, comorbidity, and use of medications for cardiovascular disease and gout. Hazard ratios and 95% confidence intervals were calculated.
In this observational cohort study, of the 1,684,314 eligible people, 116,097 developed incident AMD (6.9%). Incidence rates of AMD per 1,000 person-years were 20.1 for people with gout and 11.7 for people without gout. In multivariable-adjusted analyses, a diagnosis of gout was significantly associated with a higher risk of incident AMD with a hazard ratio of 1.39 (95% CI, 1.35, 1.43). This association was confirmed in sensitivity analyses that substituted Charlson-Romano comorbidity index continuous score with either a categorical Charlson-Romano comorbidity index score or individual Charlson-Romano index comorbidities plus hypertension, hyperlipidemia and coronary artery disease. Other covariates significantly associated with higher hazards of incident AMD were older age, female gender, White race/ethnicity, and higher Charlson-Romano comorbidity index score.
We noted a novel association of gout with AMD in the elderly. Future studies should investigate the pathways that mediate this association.
评估痛风是否与年龄相关性黄斑变性（AMD）的发生有关。
我们使用了 2006 年至 2012 年的 5%医疗保险索赔数据，纳入了所有参加医疗保险按服务收费计划（A 部分和 B 部分）且未参加医疗保险优势计划的受益人，并且居住在美国。在新发 AMD 诊断、死亡或研究结束（2012 年 12 月 31 日）发生的情况下，首先对每个人进行了 censored。我们使用多变量调整的 Cox 回归分析来评估痛风与新发 AMD 的关联，调整了人口统计学、合并症以及心血管疾病和痛风药物的使用。计算了风险比和 95%置信区间。
在这项观察性队列研究中，在 1684314 名符合条件的人群中，有 116097 人发生了新发 AMD（6.9%）。每 1000 人年的 AMD 发生率为痛风患者 20.1，无痛风患者 11.7。在多变量调整分析中，痛风诊断与新发 AMD 的风险增加显著相关，风险比为 1.39（95%CI，1.35，1.43）。敏感性分析证实了这一关联，即用分类 Charlson-Romano 合并症指数评分或个体 Charlson-Romano 指数合并症加高血压、高脂血症和冠状动脉疾病替代 Charlson-Romano 合并症指数连续评分。与新发 AMD 风险增加显著相关的其他协变量是年龄较大、女性、白种人种族/民族和较高的 Charlson-Romano 合并症指数评分。
我们注意到痛风与老年人 AMD 之间存在新的关联。未来的研究应该调查介导这种关联的途径。
