The association of smoking and alcohol use with age-related macular degeneration in the oldest old: the Study of Osteoporotic Fractures.
OBJECTIVE
To estimate the incidence of age-related macular degeneration (AMD) and the association of smoking and alcohol in a population of older women.


METHODS
Prospective cohort study.


METHODS
Subjects were women who attended the Study of Osteoporotic Fractures year-10 and year-15 follow-up clinic visits and had fundus photographs taken at both visits (n = 1958; 245 Black and 1713 White subjects; mean age at year 10 visit, 78.2 years). Forty-five degree stereoscopic fundus photographs were graded for AMD. Logistic regression was used to test whether risk factors were associated with incident AMD.


RESULTS
The overall 5-year AMD incidence was 24.1% (95% confidence interval [CI], 21.7 to 26.6) for early and 5.7% (95% CI, 4.6 to 6.8) for late. Early AMD incidence in White subjects ranged from 21.9% in those aged 74 to 79 years to 33.2% in those 80 to 84 years, but was observed at the slightly lower rate of 29.0% in subjects > or =85 years (trend P < .0001). After confounder adjustment, alcohol consumption was significantly associated with an elevated risk of incident early AMD (odds ratio [OR], 1.57; 95% CI, 1.18 to 2.11). There was an increased risk of early AMD among subjects aged 80 years or older who were smoking compared to those younger than 80 years who were not smoking (OR, 5.49; 95% CI, 1.57 to 19.20; P for interaction = .026).


CONCLUSIONS
The magnitude of the greater-than-additive effect of smoking on the age-adjusted risk of AMD reinforces recommendations to quit smoking even for older individuals.
Coleman
Anne L
AL
Department of Ophthalmology, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, School of Public Health, UCLA, Los Angeles, California 90095, USA. colemana@ucla.edu
Seitzman
Robin L
RL
Cummings
Steven R
SR
Yu
Fei
F
Cauley
Jane A
JA
Ensrud
Kristine E
KE
Stone
Katie L
KL
Hochberg
Marc C
MC
Pedula
Kathryn L
KL
Thomas
Edgar L
EL
Mangione
Carol M
CM
D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology; D044383:Black People; D015331:Cohort Studies; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology; D006801:Humans; D015994:Incidence; D008268:Macular Degeneration / Q000453:epidemiology / Q000209:etiology*; D015663:Osteoporosis, Postmenopausal / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D044465:White People; D016387:Women's Health