Cluster Randomized Controlled Trial of Intervention to Increase Participant Retention and Completed Home Visits in the Nurse-Family Partnership.

We conducted a cluster-based randomized controlled trial of an intervention designed to improve participant retention in community replication sites of the Nurse-Family Partnership (NFP). We registered 26 sites and randomized them into three groups: retention intervention (RI, N = 9), delayed RI (DRI, N = 6), or control (C, NFP as usual, N = 11). The RI consisted of training nurses to give more explicit control over the frequency of visits and content of the program to the parent participants. Two of the sites assigned to the RI, two assigned to the DRI, and two out of four nurses in one other site assigned to the DRI chose not to participate in the intervention. Primary analyses (intention to treat) contrasted changes in participant retention and completed visits (the primary outcomes) in the two intervention groups (RI and DRI) compared to control sites, focusing on differences in performance among baseline cohorts compared to cohorts enrolled during the first year during which the retention intervention was implemented. Compared to baseline, retention declined in the control sites over time but stayed the same in the RI and DRI sites (p value for interaction = 0.099). Compared to baseline, the number of completed home visits declined over time in the control sites but did not in the RI and DRI sites, producing a significant treatment difference in change in mean completed home visits over time (2.71 visits, SE = 1.164, p = 0.020). The intervention offset a decline over time in retention and completed home visits found in the control group during the time covered by this trial. Quantitative and qualitative evaluation of the intervention indicated that improvements are needed to promote its uptake.

Determinants of retinal venular diameter: the Beaver Dam Eye Study.

OBJECTIVE: To describe how retinal venular diameter changes over time for an individual and to examine differences in these changes among people with different risk profiles. DESIGN: Population-based cohort study. PARTICIPANTS: A total of 4600 persons aged 43 to 86 years from the Beaver Dam Eye Study (BDES) who participated in at least 1 examination and had venular diameter measured in the right eye. METHODS: Data from 4 examinations during a 15-year period were analyzed. Retinal venular diameter was measured from photographs at each examination by computer-assisted methods and summarized as the central retinal venular equivalent (CRVE). Associations of risk factors with concurrent CRVE measurements and changes in CRVE over time were determined using multivariate analyses. MAIN OUTCOME MEASURES: Central retinal venular equivalent. RESULTS: The CRVE tended to narrow with age. Mean CRVE was approximately 5 µm smaller (225 vs. 230 µm) for the average 70-year-old compared with the average 50-year-old, and was approximately 13 µm smaller (217 vs. 230 µm) for the average 85-year-old compared with the average 50-year-old. Male sex (beta estimate [ß] = 5.24; 95% confidence interval [CI], 3.58-6.90), history of current cigarette smoking (ß = 9.38; 95% CI, 8.26-10.49), and higher white blood cell (WBC) count (per 1000/µL: ß = 0.95; 95% CI, 0.74-1.16) were independently associated with larger concurrent CRVE, whereas higher mean arterial blood pressure (per 5 mmHg: ß = -0.36; 95% CI, -0.50 to -0.23) and higher serum high-density lipoprotein (HDL) cholesterol (per 10 mg/dl: ß = 0.89; 95% CI, -1.15 to -0.63) were independently associated with smaller concurrent CRVE. History of cardiovascular disease (CVD) (ß = -0.16; 95% CI, -0.26 to -0.06) and presence of chronic kidney disease (CKD) (ß = -0.20; 95% CI, -0.34 to -0.05) were associated with a greater decrease in CRVE over time. CONCLUSIONS: These data show that retinal venular diameter tends to narrow with age; concurrent venular diameter is independently associated with sex, blood pressure, serum HDL cholesterol, WBC count, and history of current cigarette smoking; and change in CRVE is independently associated with a history of CVD and presence of CKD. The different independent effects of these interrelated factors on CRVE highlight the complex relationship between CRVE and systemic diseases and conditions and the difficulty in determining specific causes of change in CRVE over time. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Maternal and Child Mortality: Analysis of Nurse Home Visiting in 3 RCTs.

INTRODUCTION: The impact of intensive prenatal and infant/toddler nurse home visiting on low-income mothers' and children's survival was examined in 3 RCTs following participants over 2-decade periods after trial registration during pregnancy (data gathered between 1978 and 2015 and analyzed between 2016 and 2020). METHODS: All-cause and external-cause maternal mortality and preventable-cause child mortality were examined using National Death Index data. Survival rates were calculated for all the 1,138 mothers randomized and 1,076 live-born children in the second RCT (conducted in Memphis, TN) and for all the 1,135 mothers randomized and 1,087 live-born children in the first and third RCTs combined (conducted in Elmira, NY and Denver, CO). RESULTS: There were no significant nurse home visiting-control differences in maternal mortality in Memphis or Elmira and Denver. Posthoc analysis, combining all 3 trials, suggested a reduction in external-cause maternal mortality among nurse-visited mothers (p=0.054). There was a marginally significant nurse home visiting-control difference in preventable-cause child mortality (p=0.09) in Memphis. CONCLUSIONS: These results support examining maternal and child mortality in additional nurse home visiting trials with larger samples living in disadvantaged contexts. Intensive prenatal and infant/toddler home visiting by nurses for mothers and children living in poverty may decrease premature death.

Stability of 35-mm scanners as used in ophthalmologic research.

BACKGROUND AND OBJECTIVE: To assess the consistency of digitization of 35-mm slides as practiced in ophthalmologic research and estimate the impact of variation on semi-automated retinal vessel width measurements. PATIENTS AND METHODS: A single retina slide was repeatedly digitized under various conditions on three scanner models. Average color levels were extracted from the resulting images, from which vessel widths were graded. The color channel level variations and possible correlation with width were analyzed. RESULTS: The Nikon 5000 scanner (Nikon Corp., Tokyo, Japan) had average coefficients of variation of 0.4, 2.3, and 0.5 for the red, green, and blue channel levels across all runs. The P values of the correlation between the red, green, and blue color channel levels and the width of the large retinal arteriole were .89, .27, and .58, respectively. CONCLUSION: The results suggest that the tested scanners digitize the 35-mm slides in a reliable manner without biasing the retinal vessel measurements.

The Wisconsin Epidemiologic Study of Diabetic Retinopathy XXIII: the twenty-five-year incidence of macular edema in persons with type 1 diabetes.

OBJECTIVE: To examine the 25-year cumulative incidence of macular edema (ME) and its relation to various risk factors. DESIGN: Population-based study. PARTICIPANTS: A total of 955 insulin-taking persons living in an 11-county area in southern Wisconsin with type 1 diabetes diagnosed before age 30 years who participated in baseline examinations (1980-1982) and at least 1 of 4 follow-up (4-, 10-, 14-, and 25-year) examinations (n=891) or died before the first follow-up examination (n=64). METHODS: Stereoscopic color fundus photographs were graded using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study retinopathy severity scheme. Competing risk of death was included in statistical models. MAIN OUTCOME MEASURES: Incidence of ME and clinically significant ME (CSME). RESULTS: The 25-year cumulative incidence was 29% for ME and 17% for CSME. Annualized incidences of ME were 2.3%, 2.1%, 2.3%, and 0.9% in the first, second, third, and fourth follow-up periods of the study, respectively. In univariate analyses, the incidence of ME was associated with male sex, more severe diabetic retinopathy, higher glycosylated hemoglobin, proteinuria, higher systolic and diastolic blood pressure, and more pack-years of smoking. Multivariate analyses showed that the incidence of ME was related to higher baseline glycosylated hemoglobin (hazard ratio [HR] per 1% 1.17; 95% confidence interval [CI], 1.10-1.25; P<0.001) and higher systolic blood pressure (HR per 10 mmHg 1.15; 95% CI, 1.04-1.26; P=0.004) and marginally to proteinuria (HR 1.43; 95% CI, 0.99-2.08; P=0.06). CONCLUSIONS: These data show that relatively high 25-year cumulative rates of incidence of ME were related to glycemia and blood pressure. The lower risk of incident ME in the last period of the study may reflect recent improvement in care.

Changes in visual impairment prevalence by period of diagnosis of diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy.

OBJECTIVE: To examine relationships of period of diagnosis of type 1 diabetes mellitus (T1DM) to the prevalence of visual impairment (VI). DESIGN: Population-based longitudinal study. PARTICIPANTS: Nine hundred fifty-five persons (3719 participant visits) 4 to 80 years of age at baseline who lived in an 11-county area in southern Wisconsin who were diagnosed with T1DM before 30 years of age contributed to the prevalence of VI. METHODS: Five eye examination visits occurred in the following periods: 1980 through 1982, 1984 through 1986, 1990 through 1992, 1995 through 1996, and 2005 through 2007. Age of diagnosis of T1DM was grouped as before 1960, 1960 through 1969, 1970 through 1974, and 1975 through 1979. Best-corrected visual acuity (VA) using a modification of the Early Treatment Diabetic Retinopathy protocol was measured. MAIN OUTCOME MEASURES: Visual impairment was defined as best-corrected VA in the better eye of 20/40 or worse. RESULTS: While controlling for duration of T1DM, there was a lower prevalence of VI for more recent periods of diagnosis of diabetes (odds ratio per category, 0.91; 95% confidence interval, 0.88-0.93; P<0.001). This remained while controlling for glycosylated hemoglobin, blood pressure, and other related factors. CONCLUSIONS: More recently diagnosed T1DM was associated with a lower prevalence of VI. This is likely because of the diminishing incidence of proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME) resulting from better glycemic control and more timely interventions with photocoagulation for CSME and PDR in those with more recently diagnosed T1DM.

Prenatal and Infancy Nurse Home Visiting Effects on Mothers: 18-Year Follow-up of a Randomized Trial.

BACKGROUND: Prenatal and infancy home-visiting by nurses is promoted as a means of improving maternal life-course, but evidence of long-term effects is limited. We hypothesized that nurse-visitation would lead to long-term reductions in public-benefit costs, maternal substance abuse and depression, and that cost-savings would be greater for mothers with initially higher psychological resources. METHODS: We conducted an 18-year follow-up of 618 out of 742 low-income, primarily African-American mothers with no previous live births enrolled in an randomized clinical trial of prenatal and infancy home visiting by nurses. We compared nurse-visited and control-group women for public-benefit costs, rates of substance abuse and depression, and examined possible mediators of intervention effects. RESULTS: Nurse-visited women, compared with controls, incurred $17 310 less in public benefit costs (P = .03), an effect more pronounced for women with higher psychological resources ($28 847, P = .01). These savings compare with program costs of $12 578. There were no program effects on substance abuseor depression. Nurse-visited women were more likely to be married from child age 2 through 18 (19.2% vs 14.8%, P = .04), and those with higher psychological resources had 4.64 fewer cumulative years rearing subsequent children after the birth of the first child (P = .03). Pregnancy planning was a significant mediator of program effects on public benefit costs. CONCLUSIONS: Through child age 18, the program reduced public-benefit costs, an effect more pronounced for mothers with higher psychological resources and mediated by subsequent pregnancy planning. There were no effects on maternal substance abuse and depression.

Prenatal and Infancy Nurse Home Visiting and 18-Year Outcomes of a Randomized Trial.

OBJECTIVES: Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths' cognition, academic achievement, and behavior and whether effects on cognitive-related outcomes would be greater for youth born to mothers with limited psychological resources (LPR) and on arrests and convictions among females. METHODS: We enrolled 742 pregnant, low-income women with no previous live births and randomly assigned them to receive either free transportation for prenatal care plus child development screening and referral (control; n = 514) or prenatal and infant home nurse visit (NV) plus transportation and screening (n = 228). Assessments were completed on 629 18-year-old first-born offspring to evaluate these primary outcomes: (1) cognitive-related abilities (nonverbal intelligence, receptive language, and math achievement) and (2) behavioral health (internalizing behavioral problems, substance use and abuse, sexually transmitted infections, HIV risk, arrests, convictions, and gang membership). RESULTS: Compared with control-group counterparts, NV youth born to mothers with LPR had better receptive language (effect size = 0.24; 95% confidence interval [CI]: 0.00 to 0.47; P = .05), math achievement (effect size = 0.38; 95% CI: 0.14 to 0.61; P = .002), and a number of secondary cognitive-related outcomes. NV females, as a trend, had fewer convictions (incidence ratio = 0.47; 95% CI: 0.20 to 1.11; P = .08). There were no intervention effects on other behaviors. CONCLUSIONS: The program improved the cognitive-related skills of 18-year-olds born to mothers with LPR and, as a trend, reduced female convictions but produced no other effects on youth behavioral health.

Age-period-cohort effect on the incidence of age-related macular degeneration: the Beaver Dam Eye Study.

OBJECTIVE: To examine relationships of age, period, and birth cohort with the 5-year incidence of age-related macular degeneration (AMD). DESIGN: Population-based cohort study with 4 examination visits 5 years apart from 1988 through 1990, 1993 through 1995, 1998 through 2000, and 2003 through 2005. PARTICIPANTS: Two thousand nine hundred sixty-eight persons (6603 participant visits) and 3588 persons (8184 participant visits) 43 to 86 years of age at baseline contributing to the incidence of early and late AMD, respectively. METHODS: Grading of stereoscopic fundus photographs using the Wisconsin Age-Related Maculopathy Grading System. MAIN OUTCOME MEASURES: Five-year incidence of early AMD. RESULTS: While controlling for age, there was a lower 5-year incidence of early AMD in later rather than in earlier birth cohorts (odds ratio per increasing category, 0.70; 95% confidence interval, 0.62-0.78; P<0.001). This remained while controlling for smoking, blood pressure, and other related factors. There was no evidence for a period or birth cohort effect with late AMD. CONCLUSIONS: Lower incidence of early AMD in more recent birth cohorts is likely the result of unmeasured risk factors for early AMD. Further study of possible unmeasured risk factors that may have caused this cohort effect may help to identify new modifiable risk factors for AMD. Diminishing incidence of early AMD in later birth cohorts would be expected to result in lower long-term estimates of future incidence of AMD than do current estimates that do not take this effect into account.

The Wisconsin Epidemiologic Study of Diabetic Retinopathy: XXII the twenty-five-year progression of retinopathy in persons with type 1 diabetes.

OBJECTIVE: To examine the 25-year cumulative progression and regression of diabetic retinopathy (DR) and its relation to various risk factors. DESIGN: Population-based study. PARTICIPANTS: A total of 955 insulin-taking persons living in an 11-county area in southern Wisconsin with type 1 diabetes diagnosed before age 30 years who participated in a baseline examination (1980-1982) and at least 1 of 4 follow-up (4-, 10-, 14-, and 25-year) examinations or died before the first follow-up examination (n = 64). METHODS: Stereoscopic color fundus photographs were graded using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study retinopathy severity scheme. MAIN OUTCOME MEASURES: Progression and regression of DR status. RESULTS: The 25-year cumulative rate of progression of DR was 83%, progression to proliferative DR (PDR) was 42%, and improvement of DR was 18%. Progression of DR was more likely with less severe DR, male sex, higher glycosylated hemoglobin, an increase in glycosylated hemoglobin level, and an increase in diastolic blood pressure level from the baseline to the 4-year follow-up. Increased risk of incidence of PDR was associated with higher glycosylated hemoglobin, higher systolic blood pressure, proteinuria greater body mass index at baseline, and an increase in the glycosylated hemoglobin between the baseline and 4-year follow-up examinations. Lower glycosylated hemoglobin and male sex, as well as decreases in glycosylated hemoglobin and diastolic blood pressure during the first 4 years of follow-up, were associated with improvement in DR. Persons diagnosed most recently with a similar duration of diabetes had a lower prevalence of PDR independently of glycosylated hemoglobin level, blood pressure level, and presence of proteinuria. CONCLUSIONS: These data show relatively high 25-year cumulative rates of progression of DR and incidence of PDR. The lower risk of prevalent PDR in more recently diagnosed persons possibly reflects improvement in care over the period of the study.

Supplements and age-related eye conditions the beaver dam eye study.

OBJECTIVE: To investigate the association of use of vitamin, mineral, and nonvitamin nonmineral supplements with common age-related eye diseases. DESIGN: Population-based prospective study with incidence data. PARTICIPANTS: Subjects were participants in the Beaver Dam Eye Study who contributed data in 1988 to 1990 (n = 4926), 1993 to 1995 (n = 3722), 1998 to 2000 (n = 2962), and 2003 to 2005 (n = 2375). METHODS: Use of all medications and supplements were collected from study participants at each of 4 examinations. Intraocular pressure (IOP) measurement and fundus and lens photography were done at each visit. Visual field data are available only from baseline. Photographs of the lenses, retina, and discs were graded using standard protocols by trained graders. MAIN OUTCOME MEASURES: Incidence of age-related cataracts, macular degeneration (AMD), and high IOP for one set of analyses and incidence of supplement use for the second set of analyses. RESULTS: There was little evidence of any significant associations between supplement use and incident ocular outcomes except for a small protective effect for cortical cataracts by vitamins A and D, zinc, and multivitamins and increased odds of late AMD. Late AMD was associated with incident use of vitamins A, C, and E and zinc. CONCLUSIONS: Age-related macular degeneration seems to precede use of vitamins A, C, and E and zinc. This may reflect advice by family, friends, and health care providers about the benefits of Age-Related Eye Disease Study-like supplements.

Inflammation, complement factor h, and age-related macular degeneration: the Multi-ethnic Study of Atherosclerosis.

OBJECTIVE: To describe the relationship of systemic inflammatory disease, complement factor H (CFH) Y402H (1277T-->C) genotype status and age-related macular degeneration (AMD) prevalence in a multiethnic population of whites, blacks, Hispanics, and Chinese. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: We included 5887 persons aged 45 to 84 years with gradable AMD. METHODS: Digital fundus photographs were used to measure AMD. Two years earlier, biomarkers of inflammation were measured and history of inflammatory disease and use of antiinflammatory agents obtained. MAIN OUTCOME MEASURE: Prevalence of AMD. RESULTS: While controlling for age, gender, race/ethnicity, and study site, there were no associations between systemic inflammatory factors and AMD severity. Higher levels of high-sensitivity C-reactive protein (odds ratio [OR] per standard deviation [SD] increase in natural log [ln] units, 2.34; 95% confidence interval [CI], 1.33-4.13) and interleukin-6 (OR per SD in ln, 2.06; 95% CI, 1.21-3.49) were associated with geographic atrophy but not other AMD end points. History of periodontal disease (OR, 1.68; 95% CI, 1.14-2.47) was related to increased retinal pigment. A history of arthritis was associated with soft distinct drusen (OR, 1.24; 95% CI, 1.06-1.46). A history of oral steroid use was related to large drusen (OR, 2.13; 95% CI, 1.14-3.97) and soft distinct drusen (OR, 1.76; 95% CI, 1.00-3.10) and history of cyclooxygenase 2 inhibitor use were associated with large drusen (OR, 1.50; 95% CI, 1.10-2.04), soft indistinct drusen (OR, 1.84; 95% CI, 1.09-3.10), and large drusen area (OR, 1.66; 95% CI, 1.02-2.71). Whites, blacks, and Hispanics with CFH Y402H CC variant genotype had the highest frequency of early AMD compared with those with wild TT genotype. The frequency of CFH did explain some of the difference in AMD prevalence between Chinese and Hispanics compared with whites, but did not explain the difference in prevalence between whites and blacks. CONCLUSIONS: This study confirmed associations of the Y402H CFH gene variant with AMD in nonwhite populations, but neither explained the lack of association between inflammatory factors and AMD in the cohort nor the basis for the observed differences in AMD prevalence across ethnic groups.

Further observations on the association between smoking and the long-term incidence and progression of age-related macular degeneration: the Beaver Dam Eye Study.

OBJECTIVE: To examine the association between smoking and the 15-year cumulative incidence of age-related macular degeneration (AMD). METHODS: Population-based longitudinal cohort study of people in Beaver Dam, Wisconsin, who were aged 43 to 84 years (N = 4926) in 1987-1988. Participants were examined in 1988-1990 and were reexamined at 5-year intervals during a 15-year period. Age-related macular degeneration status was determined by grading stereoscopic color fundus photographs. RESULTS: Controlling for age, sex, and baseline AMD severity, people who were current smokers at baseline, compared with those who never smoked, were at increased risk of incident early AMD (odds ratio, 1.47; 95% confidence interval, 1.08-1.99; P = .01) and for progression of AMD (odds ratio, 1.43; 95% confidence interval, 1.05-1.94; P = .02) during a 15-year follow-up. There were few associations of specific characteristics of smoking (eg, intensity, pack-years smoked, duration, and age at initiation and quitting) with AMD outcomes. CONCLUSIONS: Smoking appears to be related to the long-term incidence and progression of AMD. This has important health care implications because early AMD increases the risk of developing late AMD and smoking behavior is modifiable.

Clinically significant macular edema and survival in type 1 and type 2 diabetes.

PURPOSE: To investigate the association of clinically significant macular edema (CSME) and long-term survival in individuals with type 1 and type 2 diabetes. DESIGN: Population-based cohort study. METHODS: The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) is an ongoing prospective population-based cohort study initiated from August 21, 1980 through July 30, 1982 of individuals with diabetes diagnosed at either younger than 30 years of age (younger-onset group; n = 996) or 30 years of age or older (older-onset group; n = 1,370). Stereoscopic color retinal photographs were graded for retinopathy using the modified Airlie House classification scheme. CSME was defined by the Early Treatment Diabetic Retinopathy Study criteria. RESULTS: Prevalence of CSME was 5.9% and 7.5% for the younger- and older-onset groups, respectively. After 20 years of follow-up, 276 younger-onset and 1,197 older-onset persons died. When adjusting for age and gender, CSME was not significantly associated with all-cause mortality (hazard ratio [HR], 1.41; 95% confidence interval [CI], 0.96 to 2.07; P = .08) or ischemic heart disease mortality (HR, 1.14; 95% CI, 0.61 to 2.12; P = .68) in the younger-onset group. In the older-onset group, there was increased all-cause and ischemic heart disease mortality when CSME was present (HR, 1.55; 95% CI, 1.25 to 1.92; P < .01; and HR, 1.56; 95% CI, 1.15 to 2.13; P < .01, respectively), when adjusting for age and gender. After controlling for other risk factors, the association remained significant for ischemic heart disease (HR, 1.58; 95% CI, 1.07 to 2.35; P = .02) among those taking insulin. CSME was not significantly associated with stroke mortality in either group. CONCLUSIONS: CSME seems to be a risk indicator for decreased survival in persons with older-onset diabetes mellitus. The presence of CSME may identify individuals who should be receiving care for detection and treatment of cardiovascular disease.

The epidemiology of retinal reticular drusen.

PURPOSE: To describe the prevalence and 15-year cumulative incidence of and risk factors for reticular drusen. DESIGN: Population-based prospective study. METHODS: Four thousand nine hundred and twenty-six persons, 43 to 86 years of age, were included between 1988 and 1990, of whom 3,684, 2,764, and 2,119 participated in five-, 10-, and 15-year follow-up examinations, respectively, in Beaver Dam, Wisconsin. Main outcome measures included prevalence and 15-year incidence of reticular drusen determined by grading stereoscopic color fundus photographs. RESULTS: The prevalence at baseline and the 15-year cumulative incidence in either eye of reticular drusen was 0.7% and 3.0%, respectively. The 15-year incidence of reticular drusen varied with age from 0.4% in those 43 to 54 years of age to 6.6% in those 75 years or older at baseline (P < .001). In a multivariate model, while controlling for age, risk factors statistically significantly associated with increased risk of incident reticular drusen included: being female (odds ratio [OR], 2.8), current smoking (OR vs never, 1.9), less education (OR per category, 1.7), B-vitamin complex use (OR vs none, 2.5), single vitamin B (OR vs none, 2.9), history of steroid eye drops use (OR, 5.9), glaucoma (OR, 2.8), and more severe drusen type (e.g., soft indistinct drusen; OR, 1.4), whereas diabetes (OR, 0.1) at baseline was associated with decreased risk. Right eyes with reticular drusen at baseline had higher cumulative incidence of geographic atrophy (21% vs 9%) and exudative age-related macular degeneration [AMD] (20% vs 10%) compared with eyes with soft indistinct drusen. CONCLUSIONS: This population-based study documents the long-term cumulative incidence of reticular drusen and its risk factors and shows its association with a high risk of incident late AMD.

A longitudinal study of nonvitamin, nonmineral supplement use: prevalence, associations, and survival in an aging population.

PURPOSE: We sought to describe population and survival characteristics in nonvitamin, nonmineral (NVNM) supplement users in a population-based cohort study. METHODS: People from 43 to 86 years of age living in Beaver Dam, Wisconsin, participated in a baseline examination from 1988 to 1990 (n = 4,926) and three follow-up examinations at 5-year intervals (n = 3,722, 2,962, 2,375 at each successive examination). Medication and supplement use, medical and lifestyle factors were collected during the examination and survival was monitored through 2002. RESULTS: NVNM supplement use increased from 5% at baseline, to 6% at the second, to 21% at the third to 30% at the fourth examination. In general, younger age, vitamin or mineral use, and taking more medications was directly related to NVNM supplement use, while current smoking and history of other systemic diseases (e.g., cardiovascular disease, cancer) was inversely related to NVNM supplement use. After adjusting for age, sex, and other medical and lifestyle factors, users of NVNM supplements had lower mortality (hazard ratio, 0.74; 95% confidence interval, 0.57-0.95, p = 0.02) than nonusers. CONCLUSIONS: NVNM supplement users had a healthier lifestyle and fewer co-morbid medical conditions and were more likely to survive after adjusting for these factors than non-users.

Fifteen-year cumulative incidence of age-related macular degeneration: the Beaver Dam Eye Study.

PURPOSE: To describe the 15-year cumulative incidence of signs of early and late age-related macular degeneration (AMD). DESIGN: Population-based cohort study. PARTICIPANTS: We included 3917 persons, 43 to 86 years of age at the time of a baseline examination in 1988 through 1990 and with information collected in follow-up in 1993 through 1995, and/or 1998 through 2000, and/or 2003 through 2005. METHODS: Grading of stereoscopic fundus photographs using the Wisconsin Age-Related Maculopathy Grading System. MAIN OUTCOME MEASURES: Cumulative incidence of drusen type and size, pigmentary abnormalities, geographic atrophy, and exudative AMD accounting for competing risk of death. RESULTS: The 15-year cumulative incidence was 14.3% for early AMD (the presence of either soft indistinct drusen or the presence of pigmentary abnormalities together with any type of drusen) and 3.1% for late AMD (presence of exudative AMD or geographic atrophy). There was an increased incidence of AMD lesions with age (P<0.05). Individuals > or = 75 years of age at baseline had significantly (P<0.01) higher 15-year incidences of the following characteristics than people 43 to 54 years of age: larger drusen (125 mum in diameter, 24.1% vs 10.6%), soft indistinct drusen (18.7% vs 6.5%), retinal pigmentary abnormalities (20.2% vs 3.7%), exudative macular degeneration (4.4% vs 0.4%), and pure geographic atrophy (3.2% vs 0%). Controlling for age, compared with those with small numbers of only small hard drusen (1-2), those with large numbers of only hard drusen (> or =8) had an increased 15-year age-adjusted incidence of both soft indistinct drusen (16.3% vs 4.7%) and pigmentary abnormalities (10.6% vs 2.7%). Eyes with soft indistinct drusen or pigmentary abnormalities at baseline were more likely to develop late AMD at follow-up than eyes without these lesions (17.8% vs 1.2% and 12.9% vs 1.7%, respectively). CONCLUSIONS: We document the long-term incidence of signs of AMD and a continuum from small hard drusen to late AMD in older persons in the population. The 15-year cumulative incidence of late AMD in people > or = 75 years of age (8%) indicates a public health problem of significant proportions because the United States population this age is expected to increase by 54% between 2005 and 2025.

Retinal vein occlusion and vascular mortality: pooled data analysis of 2 population-based cohorts.

PURPOSE: To assess the association of retinal vein occlusion (RVO) with cardiovascular and cerebrovascular mortality. DESIGN: Pooled data from 2 population-based cohort studies. PARTICIPANTS: At baseline, the Beaver Dam Eye Study (BDES) examined 4926 persons aged 43 to 86 years (from 1988-1990) and the Blue Mountains Eye Study (BMES) examined 3654 persons aged 49 to 97 years (from 1992 to 1994). METHODS: Retinal vein occlusion was assessed from retinal photographs. Vascular deaths were determined using either death certificates (BDES) or the Australian National Death Index (BMES). Cox regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). MAIN OUTCOME MEASURE: Vascular (cardiovascular and cerebrovascular) mortality was determined. RESULTS: Of 8384 baseline participants, 96 (1.14%) had RVO at baseline (BDES, n = 38; BMES, n = 58). Over 12 years, 1312 (15.7%) died of cardiovascular-related conditions and 341 (4.1%) died of cerebrovascular-related conditions. Age-standardized vascular mortality rates were 26.0% and 5.3%, respectively, in persons with RVO and 17.1% and 4.5%, respectively, in those without RVO. After adjusting for age, gender, body mass index, hypertension, diabetes, smoking, glaucoma, and study site, RVO was not associated with cardiovascular-related mortality (HR, 1.2; 95% CI, 0.8-1.8) or cerebrovascular-related mortality (HR, 0.9; 95% CI, 0.4-2.1) among participants of all ages. However, in persons aged less than 70 years, baseline RVO was associated with higher cardiovascular mortality (combined BDES and BMES: HR, 2.5; 95% CI, 1.2-5.2; BDES: HR, 2.5; 95% CI, 0.9-6.9; BMES: HR, 2.1; 95% CI, 0.7-6.8). CONCLUSIONS: Retinal vein occlusion in persons aged 43 to 69 years may signal a doubling of the risk of cardiovascular mortality.

Subclinical atherosclerotic cardiovascular disease and early age-related macular degeneration in a multiracial cohort: the Multiethnic Study of Atherosclerosis.

OBJECTIVE: To investigate the relationship of subclinical atherosclerotic cardiovascular disease (CVD) and its risk factors with age-related macular degeneration (AMD) in the Multiethnic Study of Atherosclerosis. METHODS: This study included 6176 white, black, Hispanic, and Chinese participants aged 44 to 84 years from 6 communities in the United States. Measurements of subclinical CVD were performed according to standardized protocols. Fundus images were graded using the Wisconsin Age-Related Maculopathy Grading System. RESULTS: In analyses controlled for age, sex, race/ethnicity, and study location, early AMD was associated with a higher serum high-density lipoprotein cholesterol level (odds ratio per 15 mg/dL, 1.16; 95% confidence interval, 1.01-1.36) and the presence of echolucent carotid artery plaque (odds ratio for present vs no plaque, 0.37; 95% confidence interval, 0.18-0.74) in the whole cohort. Interactions of race/ethnicity and early AMD were found for carotid intima-media thickness, increasing severity of maximum carotid artery stenosis, serum triglyceride level, subclinical CVD severity, and Agatston calcium score. CONCLUSION: Few associations were found between subclinical CVD and CVD risk factors with early AMD. The findings of associations of early AMD with some signs of subclinical atherosclerotic CVD are different among the 4 racial/ethnic groups, which suggests that care must be taken in generalizing from one racial/ethnic group to another.

Statin use and the five-year incidence and progression of age-related macular degeneration.

PURPOSE: To examine the association of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) with the five-year incidence of age-related macular degeneration (AMD). DESIGN: Population-based cohort study. METHODS: settings: Beaver Dam, Wisconsin. study population: Participants included persons 53 to 96 years of age at examination in 1998 to 2000 (n = 2,962), of whom 2,204 participated in a follow-up five years later. observation procedures: Standardized procedures were used for physical examinations, blood collection, and questionnaire administration. AMD was determined by grading images of the posterior pole using a standard protocol. Standard univariate and multivariate analyses were performed. main outcome measures: Incident early and late AMD and progressed AMD. RESULTS: There were 1,347 and 1,638 persons not using statins and 339 and 429 using statins at the 1998 to 2000 examination at risk of early and late AMD, respectively. The unadjusted five-year incidence of early and late AMD, respectively, was 5.9% and 1.8% in those not using statins and 6.8% and 2.3% in those using statins. While controlling for age, gender, smoking status, and multivitamin use, a history of statin use was not associated with the five-year incidence of early AMD (odds ratio [OR] 1.16, 95% confidence interval [CI] 0.71 to 1.91, P = .55), progression of AMD (OR 1.16, 95% CI 0.75 to 1.78, P = .51) or incidence of late AMD (OR 1.27, 95% CI 0.60 to 2.69. P = .53). CONCLUSION: These findings do not show an association between statin use and the incidence or progression of AMD over a five-year period.