Incidence of exudative age-related macular degeneration among elderly americans

doi:10.1016/S0161-6420(03)00495-0

Ophthalmology

Volume 110, Issue 8, August 2003, Pages 1534-1539

https://doi.org/10.1016/S0161-6420(03)00495-0 Get rights and content

Abstract

Purpose

To estimate the 3-year incidence of exudative age-related macular degeneration (AMD) and its treatment by laser photocoagulation in elderly Americans.

Design

Population-based cohort study using insurance claims data.

Participants

A random 5% sample of Medicare beneficiaries, age 65 and older.

Methods

Incidence of exudative AMD and of laser photocoagulation for this condition was assessed based on four categories of ascertainment criteria that included procedure and diagnosis codes associated with exudative AMD, choroidal neovascularization, and its treatment.

Main outcome measures

Incidence of AMD and of associated laser photocoagulation.

Results

Overall, the 3-year incidence of exudative AMD is estimated to be between 9.4 per 1000 and 11.4 per 1000 Americans age 65 and older (depending on ascertainment criteria), based on those diagnosed and treated by ophthalmologists for the condition. These estimates bracket the measured incidence of exudative AMD in the Beaver Dam Eye Study and lie within its 95% confidence interval. The 3-year incidence of exudative AMD with attendant laser photocoagulation was 2.3 per 1000. Women were found to have a slightly higher incidence of AMD than men using all ascertainment criteria (P < 0.001), and white Americans were found to have a fivefold-to-sixfold higher ascertainment criteria than black Americans (P < 0.001).

Conclusions

The reported incidence of exudative AMD identified in the population of Medicare beneficiaries suggests that measurements on incidence for this condition derived from the Beaver Dam Eye Study can be generalized to the U.S. population.

Section snippets

Population and methods

Five years (1994–1998) of the 5% sample of Medicare medical claims data from the Standard Analytical File were used to develop a longitudinal study cohort. This file is prepared annually by the Centers for Medicare and Medicaid (formerly the Health Care Financing Administration), based on the last two digits of the beneficiary’s social security number. A period from 1994 to 1995 was defined as the “prebaseline” period, and a period from 1996 through 1998 as the study period. As is common

Results

A total of 1,041,009 Medicare beneficiaries met the enrollment criteria and were followed up in the study. As shown in Table 4, Degeneration by Age and Ascertainment Criteria No. at RiskDegenerationIncidenceLowerUpperNo. at RiskDegenerationIncidenceLowerUpper Level 2Level 3 No. at RiskNo. with Wet Age-related Macular DegenerationIncidence %95% Confidence IntervalNo. at RiskNo. with Wet Age-related Macular DegenerationIncidence %95% Confidence Interval LowerUpperLowerUpper

Discussion

Overall, the results obtained in this study are consistent with previous studies of AMD incidence in local populations and suggest that those findings are generalizable to the rest of the United States population. Given the potential biases and limitations inherent in the use of claims data for estimating incidence, the most striking finding of this study may be how close the claims data-derived estimates are to those estimates derived using precise, validated epidemiologic techniques. The

Acknowledgements

The authors thank Dr. Ronald Klein and the other investigators of the Beaver Dam Eye Study for assistance with this manuscript. The Beaver Dam Eye Study was supported by the National Eye Institute (grant no.: EY06594).

References (14)

M.R. VanNewkirk et al.
The prevalence of age-related maculopathythe visual impairment project
Ophthalmology
(2000)
R. Klein et al.
The five-year incidence and progression of age-related maculopathythe Beaver Dam Eye Study
Ophthalmology
(1997)
L.B. Ellwein et al.
Use of eye care services among the 1991 Medicare population
Ophthalmology
(1996)
A.L. Coleman et al.
Use of insurance claims databases to evaluate the outcomes of ophthalmic surgery [review]
Surv Ophthalmol
(1997)
B. Munoz et al.
Causes of blindness and visual impairment in a population of older Americansthe Salisbury Eye Evaluation Study
Arch Ophthalmol
(2000)
N.M. Bressler et al.
Five-year incidence and disappearance of drusen and retinal pigment epithelial abnormalities. Waterman study
Arch Ophthalmol
(1995)
J.B. Mitchell et al.
Using Medicare claims for outcomes research
Med Care
(1994)

There are more references available in the full text version of this article.

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^☆: Supported by Pharmacia Corp., which has a proprietary interest in the development of treatments for age-related macular degeneration.

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Incidence of exudative age-related macular degeneration among elderly americans☆

Abstract

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Population and methods

Results

Discussion

Acknowledgements

Ophthalmology

Ophthalmology

Ophthalmology

Surv Ophthalmol

Causes of blindness and visual impairment in a population of older Americansthe Salisbury Eye Evaluation Study

Arch Ophthalmol

Five-year incidence and disappearance of drusen and retinal pigment epithelial abnormalities. Waterman study

Arch Ophthalmol

Using Medicare claims for outcomes research

Med Care