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年龄相关性黄斑变性5年发生率的年代差异

Cruickshanks, K.J., Nondahl, D.M., Johnson, L.J., et al.

期刊名称:JAMA Ophthalmology

卷期:2017年第135卷第12期

摘要

摘要:重要性:在婴儿潮(1946-1964)或以后出生的人是否继续报告年龄相关性黄斑变性(AMD)风险下降是未知的。这些数据对于21世纪眼科医疗保健需求计划非常重要。目的:旨在确定5年期AMD风险是否因后代而下降,并确定是否有助于改善风险因素。设计,设置和研究对象:数据来自Beaver Dam纵向队列眼科研究(198831日至1990915日,199331日至1995615日)和Beaver Dam后代研究(200568日至200884日以及2010712日至2013321日)。这些基于人群的研究对1987年到1988年间威斯康星州Beaver Dam43岁至84岁居民以及2005年到2008年,他们的21岁至84岁之间成年子女进行了调查。根据基线调查时获得的眼底图像,共有4819名参与者处于AMD风险。从2016218日至2017622日进行数据分析,2017922日前进行更多分析。主要预后指标:使用Wisconsin年龄相关性黄斑病变分级系统对AMD进行眼底图像分级。 AMD发生率定义为5年随访检查发现纯粹地理萎缩或渗出性黄斑变性,任何类型的玻璃膜疣颜色异常,或没有色素异常的软模糊玻璃膜疣。结果:4819名受试者中,队列平均(SD)基线年龄为5411)岁;男性2117人(43.9%),女性2702人(56.1%)。最伟大的一代(出生于1901 - 1924年)的5年年龄和性别调整后AMD发生率为8.8%,沉默的一代(1925 - 1945年出生)的AMD发生率为3.0%,婴儿潮一代(1946-1964年出生)为1.0%,第十代(1965-1984年出生)为0.3%。调整年龄和性别后,每一代发生AMD的可能性比前一代低60%(相对风险0.34; 95CI0.24-0.46)。调整年龄,性别,吸烟,教育程度,运动,非高密度脂蛋白胆固醇水平和高敏C反应蛋白水平,以及使用非甾体类抗炎药,他汀类药物和多种维生素后,世代相关性仍然很明显(相对风险度,0.40; 95CI0.280.57)。结论和意义:20世纪出生队列AMD 5年风险下降。解释风险下降的因素尚不清楚。然而,这种模式与心血管疾病和老年痴呆症风险下降相一致,表明年龄较大的婴儿潮一代老年时的视网膜健康状况可能比前几代好。

Importance:Whether a reported decline in the risk of developing age-related macular degeneration (AMD) continued for people born during the Baby Boom years (1946-1964) or later is unknown. These data are important to plan for ocular health care needs in the 21st century.Objectives:To determine whether the 5-year risk for AMD declined by generation and to identify factors that contributed to improvement in risk.Design, Setting, and Participants:Data came from the longitudinal cohort Beaver Dam Eye Study (March 1, 1988, through September 15, 1990, and March 1, 1993, through June 15, 1995) and the Beaver Dam Offspring Study (June 8, 2005, through August 4, 2008, and July 12, 2010, through March 21, 2013). These population-based studies examined residents of Beaver Dam, Wisconsin, aged 43 to 84 years in 1987 through 1988 and their adult offspring aged 21 to 84 years in 2005 through 2008. A total of 4819 participants were at risk for developing AMD based on fundus images obtained at baseline visits. Data were analyzed from February 18, 2016, through June 22, 2017, with additional analyses ending September 22, 2017.Main Outcomes and Measures:Fundus images were graded for AMD using the Wisconsin Age-related Maculopathy Grading System. The incidence of AMD was defined as the presence at the 5-year follow-up examination of pure geographic atrophy or exudative macular degeneration, any type of drusen with pigmentary abnormalities, or soft indistinct drusen without pigmentary abnormalities.Results:Among the 4819 participants, the mean (SD) baseline age of the cohort was 54 (11) years; 2117 were men (43.9%) and 2702 were women (56.1%). The 5-year age- and sex-adjusted incidence of AMD was 8.8% in the Greatest Generation (born during 1901-1924), 3.0% in the Silent Generation (born during 1925-1945), 1.0% in the Baby Boom Generation (born during 1946-1964), and 0.3% in Generation X (born during 1965-1984). Adjusting for age and sex, each generation was more than 60% less likely to develop AMD than the previous generation (relative risk, 0.34; 95% CI, 0.24-0.46). The generational association (relative risk, 0.40; 95% CI, 0.28 to 0.57) remained significant after adjusting for age, sex, smoking, educational attainment, exercise, levels of non–high-density lipoprotein cholesterol and high-sensitivity C-reactive protein, and use of nonsteroidal anti-inflammatory drugs, statins, and multivitamins.Conclusions and Relevance:The 5-year risk for AMD declined by birth cohorts throughout the 20th century. Factors that explain this decline in risk are not known. However, this pattern is consistent with reported declines in risks for cardiovascular disease and dementia, suggesting that aging Baby Boomers may experience better retinal health at older ages than did previous generations.


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