American Journal of Epidemiology Advance Access published online on June 24, 2007
American Journal of Epidemiology, doi:10.1093/aje/kwm126
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Original Contribution |
Retinopathy and Survival in a Population without Diabetes
The Beaver Dam Eye Study
1 Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI
2 Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
Correspondence to Dr. Ronald Klein, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison School of Medicine and Public Health, 610 North Walnut Street #417 – WARF, Madison, WI 53726-2336 (e-mail: kleinr{at}epi.ophth.wisc.edu).
Received for publication November 29, 2006. Accepted for publication March 15, 2007.
Retinopathy is relatively common in nondiabetic populations, and its long-term prognostic implications are not certain. For this reason, the authors hypothesized that retinal alterations were associated with all-cause and cause-specific mortality in nondiabetic individuals participating in the Beaver Dam Eye Study in Wisconsin. Included in the analysis were 4,294 nondiabetic subjects aged 43–84 years examined at baseline (1988–1990). Retinopathy was classified into four groups by using retinal photographs: 1) no retinopathy, 2) presence of retinal hemorrhages only, 3) presence of retinal microaneurysms only, and 4) presence of moderate or worse retinopathy. The authors analyzed survival during 14 years of follow-up and in 5-year intervals by using time-varying covariates. Baseline prevalence of retinopathy was 7.7%. Adjusting for age, sex, and significant confounders, they observed that moderate retinopathy at baseline was associated with all-cause (hazard ratio = 1.76, 95% confidence interval: 1.16, 2.69) and ischemic heart disease (hazard ratio = 3.17, 95% confidence interval: 1.73, 5.78) mortality after 14 years of follow-up. In the 5-year-interval analysis, the presence of hemorrhages only was significantly related to increased all-cause (hazard ratio = 1.49, 95% confidence interval: 1.05, 2.12) and ischemic heart disease (hazard ratio = 2.43, 95% confidence interval: 1.48, 4.01) mortality. Study results suggest that retinal changes have possible prognostic implications regarding survival of persons without diabetes.
eye diseases; mortality; ophthalmology; retina; retinal hemorrhage
Abbreviations: CI, confidence interval; HR, hazard ratio; ICD, International Classification of Diseases
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