title: Racial differences in age-related macular degeneration rates in the United States: a longitudinal analysis of a managed care network.
abstract: OBJECTIVE
  To compare the incidence, prevalence, and hazard of nonexudative and exudative age-related macular degeneration (AMD) among different races throughout the United States.
  
  
  METHODS
  Retrospective longitudinal cohort study.
  
  
  METHODS
  Billing records of all encounters for 2 259 061 beneficiaries aged ≥40 enrolled in a large, national US managed care network from 2001 through 2007 were reviewed and the incidence and prevalence of nonexudative and exudative AMD were determined and stratified by race. Cox regression analyses determined the hazard of nonexudative and exudative AMD for each race, with adjustment for confounders.
  
  
  RESULTS
  During the study, 113 234 individuals (5.0%) were diagnosed with nonexudative and 17 181 (0.76%) with exudative AMD. After adjustment for confounders, blacks had a significantly reduced hazard of nonexudative (hazard ratio [HR]=0.75, 95% confidence interval [CI]: 0.71-0.79) and exudative AMD (HR=0.70, 95% CI: 0.59-0.83) at age 60 and a reduced hazard of nonexudative (HR=0.56, 95% CI: 0.52-0.60) and exudative AMD (HR=0.45, 95% CI: 0.37-0.54) at age 80 relative to whites. Similar comparisons for Latinos demonstrated an 18% reduced hazard for nonexudative AMD at age 80 (HR=0.82, 95% CI: 0.76-0.88) relative to whites. Asian Americans showed a 28% increased hazard for nonexudative AMD at age 60 (HR=1.28, 95% CI: 1.20-1.36) but a 46% decreased hazard for exudative AMD at age 80 (HR=0.54, 95% CI: 0.40-0.73).
  
  
  CONCLUSIONS
  Racial minorities, including Latinos and Asian Americans, do not appear to have similar risks of developing nonexudative and exudative AMD as whites. Additional studies using other sources should be conducted to determine the generalizability of this study's findings to other groups.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan 48105, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Vanderbeek
authors.forename: David N
authors.initials: DN
authors.lastname: Zacks
authors.forename: Nidhi
authors.initials: N
authors.lastname: Talwar
authors.forename: Bin
authors.initials: B
authors.lastname: Nan
authors.forename: David C
authors.initials: DC
authors.lastname: Musch
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D057092:Geographic Atrophy / Q000208:ethnology*; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015995:Prevalence; D016016:Proportional Hazards Models; D044469:Racial Groups; D012189:Retrospective Studies; D018570:Risk Assessment; D057135:Wet Macular Degeneration / Q000208:ethnology*