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F. Yu, J. Davidson, A.L. Coleman; Association between Age-related Macular Degeneration and Hip Fractures in the Medicare Population . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3080.
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Purpose: To explore the relationship between age-related macular degeneration (ARMD) and hip fractures in the Medicare population. Methods: Using a case-control design, we evaluated the association of ARMD and hip fractures. Cases were patients coded with ARMD (ICD-9: 362.50, 362.51, 362.52, 362.57) in 1995 in a 5% random sample of the Medicare database (the Health Care Financing Administration (HCFA) Physician/Supplier Part B Files), and controls were patients coded with blepharitis (ICD-9: 373.0x), chronic conjunctivitis (ICD-9: 372.1x) or blepharoconjunctivitis (ICD-9: 372.2x) and no ARMD. Medicare claims for cases and controls from 1996 to 1999 were evaluated for a code corresponding to hip fractures (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 HCFA, had a hip fracture in 1995, or lacked follow-up information during 1996 to 1999. The relationship between ARMD and hip fractures was estimated with logistic regression models. Results: In 1995, 75,310 patients were coded for ARMD and 30,893 were coded for blepharitis, chronic conjunctivitis, or blepharoconjunctivitis. During 1996 to 1999, the frequency of hip fractures was 5,931 (7.9%) in cases and 1,709 (5.5%) in the controls (OR=1.46; 95% CI: 1.38, 1.54; p<0.001). After adjusting for age, gender, race, hypertension, diabetes, primary open angle glaucoma, and cataract, the OR was 1.09 (95% CI: 1.03, 1.15; p=0.004). Conclusions: During a 4-year follow-up period, Medicare patients with a diagnosis code for ARMD had a 9% greater risk of a hip fracture than patients with diagnosis codes for conjunctivitis, blepharitis, or blepharoconjunctivitis after controlling for demographic and clinical characteristics. Reducing visual impairment secondary to ARMD may help decrease the risk for hip fractures, an important cause of morbidity and mortality world-wide.
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