June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Age-related macular degeneration and mortality in AREDS: the effect of sex and time
Author Affiliations & Notes
  • Charlotte Joslin
    Illinois Eye and Ear Infirmary, UIC Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
    Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL
  • Thasarat Vajaranant
    Illinois Eye and Ear Infirmary, UIC Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
  • Lawrence Ulanski
    Illinois Eye and Ear Infirmary, UIC Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
  • Footnotes
    Commercial Relationships Charlotte Joslin, None; Thasarat Vajaranant, None; Lawrence Ulanski, Allergan (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 245. doi:
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      Charlotte Joslin, Thasarat Vajaranant, Lawrence Ulanski; Age-related macular degeneration and mortality in AREDS: the effect of sex and time. Invest. Ophthalmol. Vis. Sci. 2013;54(15):245.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

Age-related macular degeneration (AMD), stroke and cardiovascular disease (inclusive of all circulatory disease) share risk factors and a similar pathogenesis. Previous studies yield mixed associations, potentially due to differences in follow-up time that minimize sample size and study power or alter competing risks, as well as an absence of sex-stratified results masking sex/gender differences.

 
Methods
 

The Age-Related Eye Disease Study (AREDS) dataset was used for secondary data analysis. Standard AREDS categories (1, 2, 3 and 4) were used to assess the hazard of baseline AMD status on all-cause and circulatory disease mortality. Cause of death was based on hospital records and death certificates collected during AREDS (11/92 - 12/05), and a search of the National Death Index (NDI) after the study conclusion. The proportionality hazard assumption was tested by including time-dependent covariates in the model using PROC PHREG to assess the hazard ratio (HR) and 95% confidence interval (95% CI) for the effect of AMD on mortality in whites (SAS v9.3, Cary, NC). Multivariable Cox Proportional Hazard regression models were fit adjusting for covariates and stratifying on non-proportional predictors to estimate the HR overall at multiple time points, including survival at 5-, 7-, and 10-years for 1) any death; and, 2) death due to circulatory disease.

 
Results
 

The mean follow-up among 4116 subjects was 9.6 years, with 967 of 1096 deaths identified during AREDS (Table 1). Regression models (Table 2) generally show a significant HR between AMD and circulatory system death, in which the magnitude of association is stronger 1) in men than women; 2) with increasing AMD severity; and, 3) with shorter vs. longer survival analysis. Among all-cause mortality, a similarly increased HR, dampened vs. circulatory deaths, exists that is stronger in men and increases with increasing AMD severity; HR differences by survival duration are less apparent.

 
Conclusions
 

Results suggest a significant association between increasing AMD severity and mortality. Variation in the strength of association exists by sex for both all-cause and circulatory disease mortality. Convergence in the HR between AMD and mortality by length of survival analysis comparing circulatory disease vs. all-cause mortality suggests the importance of competing risks in longer survival analyses.

     
Keywords: 412 age-related macular degeneration • 464 clinical (human) or epidemiologic studies: risk factor assessment • 413 aging  
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