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E. Anastasopoulos, F. Yu, A.L. Coleman; Non–Neovascular Age–Related Macular Degeneration Associated With Increased Incident Risk of Hip Fractures in the Medicare Population . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3313.
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Purpose:To explore the relationship between age–related macular degeneration (AMD) and the incidence of hip fractures in the Medicare population. Methods: Using a 5% random sample of Medicare databases (Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Part B Files and Denominator Files), we identified patients coded with neovascular AMD (ICD–9: 362.52) and non–neovascular AMD (ICD–9: 362.50, 362.51, 362.57) in 1995. Medicare claims from 1996 to 1999 were then evaluated for everyone with a code corresponding to hip fracture (ICD–9: 820.xx). Patients were excluded if they were under 65 years of age, did not reside in the 50 United States or the District of Columbia, did not have Part–B coverage, had HMO coverage that was not processed by CMS, had a hip fracture in 1995, or lacked follow–up information. The relationship between AMD and hip fractures was analyzed with multiple logistic regression models, adjusting for potential baseline risk factors including age, gender, race/ethnicity, CMS region of residence, length of follow–up, and the indicators for the presence of primary open–angle glaucoma, cataract, hypertension, cardiac vascular disease, diabetes, or hyperlipidemia. Results: Of 1,089,436 of eligible Medicare beneficiaries in 1995, 8,077 (0.74%) patients were coded for neovascular AMD and 67,392 (6.2%) were coded for non–neovascular AMD. During 1996 to 1999, the frequency of hip fractures was 55,911 (5.1%). The 4–year incidence of hip fractures was higher in both neovascular AMD cases (7.7%; OR=1.62; 95% CI: 1.49, 1.75) and non–neovascular AMD cases (7.9%; OR=1.66; 95% CI: 1.61, 1.71) than in patients without AMD (4.9%). After adjusting for potential risk factors, the 4–year rate of hip fractures was statistically significantly higher in patients with non–neovascular AMD than in patients without AMD (OR=1.11; 95% CI: 1.08, 1.15; p<0.001), while the 4–year rate of hip fractures was estimated to be higher in neovascular AMD patients than in patients without AMD but not significantly so (OR=1.05; 95% CI: 0.96, 1.14; p=0.272). Conclusions: Compared to Medicare patients without diagnosis codes for AMD after controlling for demographic and clinical characteristics, Medicare patients with diagnosis codes for non–neovascular AMD had an 11% greater risk of a hip fracture during a 4–year follow–up period.
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