Abstract
Purpose:
Smoking has been identified as a major modifiable risk factor for the development of macular degeneration. The exact agents and mechanisms by which smoking contributes to development of macular degeneration (ARM) are unknown. The risk profiles of different types of tobacco products vary. The combustion of tobacco produces a complex mix of over 7000 chemicals 70 of which are known to be carcinogenic. Chewed or sucked tobacco produces a substantially higher nicotine load than does the combustion of tobacco. The purpose of this study is to evaluate the association of the use of tobacco combustion products versus other nicotine delivery methods and ARM.
Methods:
Data from the 2005 -2008 NHANES was obtained from the National Center for Health Statistics. Data from African-Americans Whites and Mexican Americans were pooled. Participants were asked at the medical clinic interview if they used nicotine products. Further questions elicited the types of tobacco products used (cigarettes, pipes, cigars, snuff, snu). All combustion products were combined to form a single variable. Chewed, dipped, and sucked tobacco were combined into a single variable as was the use of nicotine gum or patches. Macular degeneration was graded in each eye as none, early, and late. A further ARM variable was created to encompass those at risk of late ARM which approximated the AREDS risk categories 3 and 4. Descriptive statistics and logistic regression analyses were used to evaluate the association of worst eye ARM, any ARM and at risk ARM to the type of tobacco product used. All analyses accounted for the complex sample design.
Results:
Approximately 24% of this cohort (23.9%, 95%CI 21.4, 26.5) within the US population reported using nicotine products. Of those 91.7% (95%CI 89.7,93.7) used combustion products, 7.4%(95%CI 5.5, 9.4) used oral tobacco and 0.8%(95%CI 0.2, 1.5)used nicotine patches or gum. Compared to persons with no reported nicotine use persons using tobacco combustion products had an increased risk of worst eye ARM(OR 1.5 95%CI 1.1, 2.0), any level ARM(OR 1.4 95% CI 1.0, 2.0) and at risk ARM (OR 1.2, 95% CI 1.0, 1.6) after controlling for age, race and gender. In contrast, persons using oral tobacco had no increased association with ARM.
Conclusions:
Tobacco combustion products but not oral tobacco use appears to be associated with macular degeneration. This suggests that nicotine exposure is not a major risk for ARM.
Keywords: 459 clinical (human) or epidemiologic studies: biostatistics/epidemiology methodology •
412 age-related macular degeneration