American Journal of Epidemiology Advance Access originally published online on November 16, 2006
American Journal of Epidemiology 2007 165(4):375-382; doi:10.1093/aje/kwk022
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ORIGINAL CONTRIBUTIONS |
Association between Circulating White Blood Cell Count and Long-Term Incidence of Age-related Macular Degeneration
The Blue Mountains Eye Study
1 Department of Community, Occupational, and Family Medicine, National University of Singapore, Republic of Singapore
2 Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, New South Wales, Australia
Correspondence to Dr. Anoop Shankar, Department of Community, Occupational, and Family Medicine, National University of Singapore, Republic of Singapore 117597 (e-mail: ashankar{at}nus.edu.sg).
Received for publication March 3, 2006. Accepted for publication July 12, 2006.
Inflammatory processes are implicated in the development and progression of age-related macular degeneration (AMD). However, there are limited data on longitudinal associations between systemic markers of inflammation and AMD. The authors examined the prospective relation between the circulating white blood cell (WBC) count and early and late AMD in a population-based cohort of 3,654 participants, aged 49–97 years, in the Blue Mountains region, Australia. The main outcome of interest was the 10-year incidence of early and late AMD among individuals free from corresponding disease at the baseline (1992–1994). An elevated baseline WBC count was associated with early AMD incidence, independent of smoking and other major confounders. The multivariable relative risk comparing tertile 3 of WBC count (>6.7 x 109 cells/liter) with tertile 1 (
5.5 x 109 cells/liter) was 1.85 (95% confidence interval: 1.33, 2.58). The association between WBC count and early AMD was present consistently in analyses of different early AMD lesions, including incident pigmentary abnormalities and soft indistinct/reticular drusen. Moreover, this association persisted in subgroup analyses by gender and smoking. An elevated WBC count at baseline was not consistently associated with late AMD incidence. This study provides population-based evidence supporting a longitudinal association between the circulating WBC count, a widely available marker of inflammation, and incidence of early AMD.
aged; Australia; inflammation; leukocyte count; macular degeneration
Abbreviations: AMD, age-related macular degeneration; CI, confidence interval; RR, relative risk; WBC, white blood cell
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