Age-Related Macular Degeneration and Mortality: A Systematic Review and Meta-Analysis

<p><b><i>Purpose</i></b>: Age-related macular degeneration (AMD) is the leading cause of severe, irreversible vision loss in older adults. Evidence for an association between AMD and mortality remains inconclusive despite evidence for an association with cardiovascular and inflammatory diseases. We aim to compare all-cause, cardiovascular and cancer mortality between those with early or late AMD and control study participants.</p> <p><b><i>Methods</i></b>: A protocol was registered at PROSPERO (CRD42015020622). A systematic search of Medline (Ovid), PubMed, and Embase (Ovid) was conducted on 6 June 2015. Reference lists from identified studies and four clinical trial registries were searched for additional studies. Participants were required to be over the age of 40 years, and AMD status must have been objectively assessed. The Risk Of Bias In Non-Randomized Studies – of Interventions (ROBINS-I) tool was used to assess the risk of bias. Random-effects meta-analyses were performed.</p> <p><b><i>Results</i></b>: A total of 12 reports from 10 studies were included in the meta-analysis. Late AMD was associated with elevated rates of all-cause (nine studies, hazard ratio (HR) 1.20, 95% confidence interval, CI, 1.02–1.41) and cardiovascular mortality (six studies, HR 1.46, 95% CI 1.13–1.98), but early AMD was not (all-cause mortality, 10 studies, HR 1.06, 95% CI 0.98–1.14; cardiovascular mortality, five studies, HR 1.12, 95% CI 0.96–1.31). There was no evidence of an association between early or late AMD and cancer mortality (early AMD, three studies, HR 1.17, 95% CI 0.78–1.75; late AMD, three studies, HR 1.01, 95% CI 0.77–1.33).</p> <p><b><i>Conclusion</i></b>: Late AMD is associated with increased rates of all-cause and cardiovascular mortality, suggesting shared pathways between late AMD and systemic disease.</p

SP IPTp and ITN coverage between 1997 and 2006.

<p>Percentage of women receiving the first dose of IPTp (dashed line), second dose of IPTp (dotted line), and women reporting bednet use (solid line). Error bars indicate 95% CI.</p

Summary of parasite density among malaria infected women from 1999 to 2006.

<p>Lines indicate geometric mean parasite density and error bars indicate 95% CI.</p

Association between bednet usage and prevalence of parasitemia, anemia and LBW^a.

<p>NOTE. –LBW  =  Low Birth Weight; OR  =  Odds Ratio; CI  =  Confidence Interval;</p>a<p>Adjusted for year and season of delivery, gravidity and 6 months rainfall prior to delivery.</p>b<p>Odds Ratio for women using bednet compared to women who did not use bednet.</p>c<p>Predicted mean change for women using bednet compared to women who did not use bednet.</p

Changes in prevalence of parasitemia, anemia and LBW due to time, rainfall, gravidity and season^a.

<p>NOTE. –LBW  =  Low Birth Weight; OR  =  Odds Ratio; CI  =  Confidence Interval;</p>a<p>Mutually adjusted for year of enrollment, rainfall, gravidity and season of enrollment;</p>b<p>Total rainfall over 6 months prior to delivery date.</p

Prevalence of parasitemia, anemia and LBW and monthly rainfall in Chichiri from 1997 to 2006.

<p>Lines indicate prevalence and error bars indicate 95% CI, bars indicate accumulated monthly rainfall</p

Survival Bias When Assessing Risk Factors for Age-Related Macular Degeneration: A Tutorial with Application to the Exposure of Smoking

<p><i><b>Purpose</b></i>: We illustrate the effect of survival bias when investigating risk factors for eye disease in elderly populations for whom death is a competing risk. Our investigation focuses on the relationship between smoking and late age-related macular degeneration (AMD) in an observational study impacted by censoring due to death.</p> <p><i><b>Methods</b></i>: Statistical methodology to calculate the survivor average causal effect (SACE) as a sensitivity analysis is described, including example statistical computing code for Stata and R. To demonstrate this method, we examine the causal effect of smoking history at baseline (1990–1994) on the presence of late AMD at the third study wave (2003–2007) using data from the Melbourne Collaborative Cohort Study.</p> <p><i><b>Results</b></i>: Of the 40,506 participants eligible for inclusion, 38,092 (94%) survived until the start of the third study wave, 20,752 (51%) were graded for AMD (60% female, aged 47–85 years, mean 65 ± 8.7 years). Late AMD was detected in 122 participants. Logistic regression showed strong evidence of an increased risk of late AMD for current smokers compared to non-smokers (adjusted naïve odds ratio 2.99, 95% confidence interval, CI, 1.74–5.13). Among participants expected to be alive at the start of follow-up regardless of their smoking status, the estimated SACE odds ratio comparing current smokers to non-smokers was at least 3.42 (95% CI 1.57–5.15).</p> <p><i><b>Conclusions</b></i>: Survival bias can attenuate associations between harmful exposures and diseases of aging. Estimation of the SACE using a sensitivity analysis approach should be considered when conducting epidemiological research within elderly populations.</p

Validation of the Refugee Health Screener-15 for the assessment of perinatal depression among Karen and Burmese women on the Thai-Myanmar border

<div><p>Perinatal depression is common, and left untreated can have significant and long-lasting consequences for women, their children and their families. Migrant women are at particular risk of perinatal depression as a result of a multitude of stressors experienced before, during and after migration. Identification of perinatal depression among migrant women—particularly those living in low- and middle-income regions—remains challenging, partly due to the lack of locally-validated and culturally appropriate screens tools. This study formally validates Burmese and Sgaw Karen versions of the <i>Refugee Health Screener-15</i> (RHS-15) as a screening tool for perinatal depression among migrant women living on the Thai-Myanmar border. The <i>Structured Clinical Interview for the Diagnosis of DSM-IV Disorders</i> (SCID) was used as the gold-standard comparator. Complete results were obtained for 235 Burmese-speaking and 275 Sgaw Karen-speaking women. Despite displaying reasonable psychometric properties, a number of shortcomings associated with the RHS-15 limited its utility in this setting. The Likert-type response categories of the RHS-15 proved problematic in this low-literacy population. Combined with the relative superiority and greater ease of administration of the SCID, the RHS-15 is not recommended as the tool of choice for detecting perinatal depression in this setting.</p></div

Receiver operating characteristic curve for the Burmese Refugee Health Screener items 1–14.

<p>Receiver operating characteristic curve for the Burmese Refugee Health Screener items 1–14.</p

Baseline characteristics of study participants by language of interview.

<p>Baseline characteristics of study participants by language of interview.</p