Age-related macular degeneration and mortality: the Melbourne Collaborative Cohort Study

To assess associations between features of age-related macular degeneration (AMD) and mortality. A total of 21 129 participants from the Melbourne Collaborative Cohort Study aged 47–85 years (60% female) were assessed for AMD (2003–2007). Mortality data to December 31, 2012 were obtained through linkage with the National Death Index. Associations were assessed using Cox regression, adjusting for age, sex, smoking, region of birth, education, physical activity, diet and alcohol. Late AMD was identified in 122 (0.6%) participants, including those with choroidalneovascularisation (n=55, 0.3%), geographic atrophy (n=87, 0.4%) and reticular pseudodrusen (n=87, 0.4%). After a median follow-up period of 8.1 years, 1669 (8%) participants had died, including those from cardiovascular diseases (386), tobacco-related cancers (179), and neurodegenerative disease (157). There was evidence of an increased rate of all-cause mortality for those with choroidalneovascularisation (Hazard Ratio (HR) 1.71 95% CI 1.06–2.76) and geographic atrophy (HR 1.46 95% CI 0.99–2.16). Choroidalneovascularisation was also associated with an increased rate of cardiovascular mortality (HR 3.16 95% CI 1.62–6.15) and geographic atrophy was associated with an increased rate of death from tobacco-related cancer (HR 2.86 95% CI 1.15–7.09). Weak evidence was also present for an association between choroidalneovascularisation and death from neurodegenerative disease (HR 2.49 95% CI 0.79–7.85). Neither reticular pseudodrusen nor the earlier stages of AMD were associated with mortality. Late AMD is associated with an increased rate of all-cause mortality. Choroidalneovascularisation and geographic atrophy were associated with death from cardiovascular disease and tobacco-related cancer, respectively.