title: Mortality in Older Persons with Retinopathy and Concomitant Health Conditions: The Age, Gene/Environment Susceptibility-Reykjavik Study.
abstract: To assess the impact of retinopathy on mortality in older persons with concomitant health conditions.
  
  
  
  Population-based prospective cohort study.
  
  
  
  A total of 4966 individuals aged 67 to 96 years (43.2% were male) from the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-RS).
  
  
  
  Retinopathy was evaluated from digital fundus images (2002-2006) using the modified Airlie House adaptation of the Early Treatment Diabetic Retinopathy Study protocol. Mortality was assessed through September 2013 (cause of death assigned through 2009). Cox proportional hazards regression models, with age as the time scale, estimated the association between retinopathy and death while controlling for risk factors and the presence of concomitant health conditions.
  
  
  
  Mortality from all causes and cardiovascular disease (CVD).
  
  
  
  Among the 4966 participants, 503 (10.1%) had diabetes and 614 (12.4%) had retinopathy at baseline. A subset of these (136 [2.7%]) had both diabetes and retinopathy. After a median follow-up of 8.6 years, 1763 persons died, 276 (45.0%) with retinopathy and 1487 (34.2%) without retinopathy, of whom 76 and 162 persons, respectively, also had diabetes. There were 366 deaths from CVD through 2009, 72 (11.7%) in persons with retinopathy and 294 (6.8%) in those without retinopathy. In multivariable analyses, retinopathy was significantly associated with all-cause mortality (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.10-1.43; P < 0.01) and CVD-related mortality (HR, 1.57; 95% CI, 1.20-2.06; P < 0.01). Findings were more striking in men: all-cause HR, 1.33 (95% CI, 1.11-1.60) and CVD HR, 1.81 (95% CI, 1.25-2.63). Risk of mortality was further increased among those with retinopathy concomitant with microalbuminuria (all-cause HR, 1.70; 95% CI, 1.03-2.23, and CVD HR, 2.04; 95% CI, 1.27-3.28) and those with retinopathy, microalbuminuria, and diabetes (all-cause HR, 2.01; 95% CI, 1.22-3.31, and CVD HR, 5.24; 95% CI, 1.91-14.42). History of clinical stroke increased the risk of CVD-related mortality among persons with retinopathy (HR, 3.30; 95% CI, 2.05-5.32), particularly those with retinopathy and diabetes (HR, 5.38; 95% CI, 1.80-16.06).
  
  
  
  Even minimal retinopathy was a significant predictor of increased mortality in older persons, particularly men, irrespective of diabetes status. Persons with retinopathy may warrant closer clinical management of general health.
authors.affiliation: Division of Epidemiology and Clinical Applications, Intramural Research Program, National Eye Institute, National Institutes of Health, Bethesda, Maryland. Electronic address: diana.fisher@nih.gov.
authors.forename: Diana E
authors.initials: DE
authors.lastname: Fisher
authors.affiliation: Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Ophthalmology, Landspitali University Hospital, Reykjavik, Iceland.
authors.forename: Fridbert
authors.initials: F
authors.lastname: Jonasson
authors.affiliation: Ophthalmology and Visual Sciences, University of Wisconsin Madison, Madison, Wisconsin.
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.affiliation: Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Geriatrics, Landspitali University Hospital, Reykjavik, Iceland.
authors.forename: Palmi V
authors.initials: PV
authors.lastname: Jonsson
authors.affiliation: Icelandic Heart Association, Kopavogur, Iceland.
authors.forename: Gudny
authors.initials: G
authors.lastname: Eiriksdottir
authors.affiliation: Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute of Aging, National Institutes of Health, Bethesda, Maryland.
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.affiliation: Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Icelandic Heart Association, Kopavogur, Iceland.
authors.forename: Vilmundur
authors.initials: V
authors.lastname: Gudnason
authors.affiliation: Division of Epidemiology and Clinical Applications, Intramural Research Program, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: Cotch
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D059647:Gene-Environment Interaction; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012164:Retinal Diseases / Q000150:complications / Q000401:mortality*; D012307:Risk Factors; D012737:Sex Factors