Attributable risk estimates for cataract to prioritize medical and public health action.
Attributable risk estimates for cataract to prioritize medical and public health action.
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发表时间：
2000-11
影响因子：
4.4
通讯作者：
Catherine A. McCarty;Mukesh B Nanjan;H. Taylor
中科院分区：
文献类型：
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作者：
Catherine A. McCarty;Mukesh B Nanjan;H. Taylor
目的 白内障是世界上最常见的致盲原因。本研究的目的是评估维多利亚州 40 岁及以上人群的代表性样本中与已确定的皮质白内障、核白内障和后囊下 (PSC) 白内障风险因素相关的人群归因风险。方法 采用整群、分层抽样，并通过家庭普查招募参与者。在当地设立的测试点，进行标准化临床检查以评估白内障，并进行个人访谈以量化潜在的风险因素。采用多因素Logistic回归分析确定与三类白内障相关的独立危险因素，并计算人群归因风险。结果 共有 3271 名城镇居民（符合资格的 83%）和 1473 名农村居民（92%）参与。城镇居民年龄40～98岁，平均59岁，其中男性1511人，占46%。农村居民年龄40～103岁，平均60岁，其中男性701人，占48%。皮质性白内障的总体患病率为 12.1%（95% CL 10.5, 13.8），核性白内障为 12.6%（95% CL 9.61, 15.7），PSC 白内障为 4.93%（95% CL 3.68, 6.17）。皮质性白内障的重要危险因素包括年龄、女性、糖尿病病史超过 5 年、痛风病史超过 20 年、关节炎、近视、平均每年眼睛 UV-B 暴露以及白内障家族史（父母或兄弟姐妹）。核性白内障的显着危险因素包括年龄、女性、农村居住、年龄相关性黄斑病、糖尿病超过 5 年、吸烟超过 30 年以及近视。 PSC白内障的显着危险因素是年龄、农村居住、噻嗪类利尿剂的使用和近视。在可改变的危险因素中，眼睛 UV-B 暴露解释了社区中 10% 的皮质性白内障，而吸烟则解释了 17% 的核性白内障。结论 由于环境中几乎普遍暴露于 UV-B，眼部保护是皮质性白内障最高的可改变归因风险之一，因此将成为公共卫生干预的理想目标。戒烟运动可以扩大到纳入有关社区中与长期吸烟相关的白内障过多的信息。年龄、性别和长期用药等不可改变的风险因素对于白内障高风险人群的及时转诊和治疗具有影响。
PURPOSE Cataract is the most common cause of blindness in the world. The purpose of this study was to estimate the population attributable risk associated with identified risk factors for cortical, nuclear, and posterior subcapsular (PSC) cataract in a representative sample of the Victorian population aged 40 years and older. METHODS Cluster, stratified sampling was used and participants were recruited through a household census. At locally established test sites, standardized clinical examinations were performed to assess cataract and personal interviews were conducted to quantify potential risk factors. Multivariate logistic regression was used to determine the independent risk factors associated with the three types of cataract, and the population attributable risk was calculated. RESULTS A total of 3271 (83% of eligible) of the urban residents and 1473 (92%) rural residents participated. The urban residents ranged in age from 40 to 98 years (mean, 59 years), and 1511 (46%) were men. The rural residents ranged in age from 40 to 103 years (mean, 60 years), and 701 (48%) were men. The overall prevalence of cortical cataract was 12.1% (95% CL 10.5, 13.8), nuclear cataract 12.6% (95% CL 9.61, 15.7), and PSC cataract 4.93% (95% CL 3.68, 6.17). Significant risk factors for cortical cataract included age, female gender, diabetes for greater than 5 years, gout for greater than 20 years, arthritis, myopia, average annual ocular UV-B exposure, and family history of cataract (parents or siblings). Significant risk factors for nuclear cataract included age, female gender, rural residence, age-related maculopathy, diabetes for greater than 5 years, smoker for greater than 30 years, and myopia. The significant risk factors for PSC cataract were age, rural residence, thiazide diuretic use, and myopia. Of the modifiable risk factors, ocular UV-B exposure explains 10% of the cortical cataract in the community, and cigarette smoking accounts for 17% of the nuclear cataract. CONCLUSIONS Because of the near universal exposure to UV-B in the environment, ocular protection has one of the highest modifiable attributable risks for cortical cataract and would therefore be an ideal target for public health intervention. Quit smoking campaigns can be expanded to incorporate information about the excess cataract in the community associated with long-term smoking. Nonmodifiable risk factors such as age, gender, and long-term medication use have implications for the timely referral and treatment for those at higher risk of cataract.