Elsevier

Ophthalmology

Volume 106, Issue 6, 1 June 1999, Pages 1056-1065
Ophthalmology

Age-related maculopathy in a multiracial United States population: The national health and nutrition examination survey III

https://doi.org/10.1016/S0161-6420(99)90255-5Get rights and content

Abstract

Objective

To investigate the prevalence of and risk factors for age-related maculopathy (ARM) in three racial/ethnic groups: non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans.

Design

A nationally representative population-based, cross-sectional study.

Participants

A total of 8270 persons 40 years of age or older, a sample of the Third National Health and Nutrition Examination Survey.

Main outcome measures

Age-related maculopathy was determined by the grading of fundus photographs using a standardized protocol.

Results

The prevalence of any ARM in the civilian noninstitutionalized United States population including those 40 years of age or older was 9.4% (95% confidence interval [CI], 8.2, 10.6) as estimated from the sample. After adjusting for age, there was no difference in the prevalence of early ARM (defined largely by the presence of soft drusen) by ethnic/racial group. However, for the less frequent component lesions of early ARM (increased retinal pigment and retinal pigment epithelial depigmentation), the odds ratios (95% CIs) comparing non-Hispanic blacks to non-Hispanic whites were 0.47 (0.31, 0.74) and 0.59 (0.33, 1.04), respectively, and for comparing Mexican-Americans to non-Hispanic whites, they were 0.41 (0.21, 0.81) and 0.72 (0.44, 1.19), respectively. For late ARM, the odds ratio (95% CI) for non-Hispanic blacks compared to non-Hispanic whites was 0.34 (0.10, 1.18) and for Mexican-Americans compared to non-Hispanic whites, it was 0.25 (0.07, 0.90). Other than age, none of the personal, medical, or physiologic variables studied were statistically significantly associated with any of the ARM endpoints in any of the three races/ethnic groups.

Conclusion

Overall, rates of any ARM (including all early and late lesions) are not significantly different among non-Hispanic blacks, Mexican-Americans, and non-Hispanic whites. However, the rates of individual lesions suggest that non-Hispanic whites and Mexican-Americans may be protected against retinal pigment abnormalities and lesions associated with late ARM. There appears to be little influence of personal, medical, and environmental factors studied on these results. Further studies in larger populations of older persons in these ethnic groups would likely clarify these relations.

Section snippets

Population

The NHANES is a periodic national survey conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. The NHANES is designed to provide national statistics on the health and nutritional status of the civilian noninstitutionalized population. Participation includes household interviews and standardized physical examinations.

The NHANES III survey is based on a complex, multistage area probability sample design. Children younger than 5 years of age,

Results

Weighted age- and gender-specific estimates of the prevalence of drusen, soft drusen, RPE depigmentation, increased retinal pigment, exudative macular degeneration, geographic atrophy, early ARM, and late ARM are presented in Table 4 for each of the race/ethnic subgroups. For whites, we have divided the age groups into three categories (40–59, 60–74, and ≥75 years of age). The data have been collapsed into broader age groups (40–59 and ≥60 years of age) for non-Hispanic blacks and

Comments

The NHANES III provides unique prevalence data on ARM in a nationwide, multiracial, population-based sample of persons older than 40 years of age. Standardized procedures were used for measuring risk factors and for obtaining color fundus photographs of the macula, and an objective system was used for grading these photographs for maculopathy.

In this study, after adjusting for age, the frequency of early ARM was similar in non-Hispanic whites compared with that of non-Hispanic blacks and

Acknowledgements

The authors thank Scot E. Moss, Stacy Meuer, Carol Hoyer, Moneen Meuer, Dayna Dalton, and Michael Neider for their contributions to data analysis and management. A complete list of acknowledgments can be found in the Plan and Operation of the Third National Health and Nutrition Examination Survey, 1988–1994. Programs and Collection Procedures Series 1. DHHS Publication, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National

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