Periodontitis Associated With Increased Risk of Developing Age-Related Macular Degeneration

Patients with periodontitis had an increased risk of developing age-related macular degeneration (AMD) compared with individuals without the inflammatory disease, researchers in Taiwan found in what they said was the first cohort study to investigate the relationship between periodontitis and AMD.

The research, which was published in Retina, used medical data of 1 million randomly selected individuals from the National Health Insurance Research Database (provided via the Longitudinal Health Insurance Database) with a 13-year follow-up to retrospectively evaluate the development of AMD among patients with periodontitis. A total of 83,322 study subjects (41,661 in the periodontitis group who were newly diagnosed with AMD between January 1, 2000, and December 31, 2012, and 41,661 in the comparison group) with a mean age of 60 years were enrolled in the study. The researchers excluded people who were diagnosed with AMD before the index date.

The researchers found that the incidence rates (per 1,000 person-years) of AMD were 5.95 in the periodontitis group and 3.41 (both P <.001) in the comparison group. Patients with periodontitis had a significantly higher risk of developing AMD (hazard ratio (HR) = 1.73; 95% CI, 1.60-1.86), even after adjusting for age, sex, and comorbidities (adjusted HR (aHR) = 1.58; 95% CI, 1.46-1.70) for AMD.

The incidence rates of nonexudative AMD were 5.43 and 3.13 per 1000 person-years in the periodontitis group and the non-periodontitis group, respectively. Patients with periodontitis had a 1.72-fold significantly higher risk of developing the nonexudative type of AMD (HR = 1.72; 95% CI, 1.59–1.86, P <.001) and a 1.57-fold higher risk (95% CI, 1.45–1.70, P <.001) of developing that type after adjusting for age, sex, and comorbidities than the group without periodontitis. 

The incidence rates of exudative AMD were 0.52 and 0.28 per 1000 person-years in the periodontitis group and the non-periodontitis group, respectively. After adjusting for age, sex, and comorbidities, patients with periodontitis had a 1.72-fold higher risk of developing the exudative type of AMD (aHR = 1.72; 95% CI, 1.32–2.23, P <.001) than the patients without periodontitis.

Patients with periodontitis aged 50 to 64 years (aHR = 1.48; 95% CI, 1.34–1.64) and at least 65 years (aHR = 1.76; 95% CI, 1.57–1.97) and female patients (aHR = 1.40; 95% CI,  1.26–1.55), male patients (aHR = 1.82; 95% CI, 1.63–2.04), patients without comorbidity (aHR = 1.92; 95% CI, 1.6–2.26), and patients with at least one comorbidity (aHR = 1.52; 95% CI, 1.40–1.66) had a significantly increased risk of developing AMD compared with subjects without periodontitis.

After adjustments for age, sex and comorbidities, the researchers found that people who were at least aged 65 years (aHR = 1.98; 95% CI, 1.84-2.14, P <.001), had hypertension (aHR = 1.24; 95% CI, 1.15-1.35, P <.001), diabetes mellitus (aHR = 1.54; 95% CI, 1.38–1.71, P <.001), hyperlipidemia (aHR = 1.19; 95% CI, 1.10–1.29, P <.001), asthma/COPD (aHR = 1.20; 95% CI, 1.10–1.29, P <.001), and chronic liver disease and cirrhosis (aHR = 1.19; 95% CI, 1.10–1.29, P <.001) also had a significantly higher risk of developing AMD.

Limitations of the study included the potential for bias because of possible unmeasured or unknown confounders, the lack of comprehensive data that could be confounding factors (such as living habits, family history, and diet style), the lack of analysis of genetic factors that could influence impact the progression of the disease, and the lack of recording severity classification of the disease in the database.

“In conclusion, our data show that people with periodontitis could be at a greater risk of developing AMD than those without periodontitis,” the researchers said. “These patients may need to pay attention to maintain oral health and to monitor the ocular health. However, we need more evidence to support this association.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.

Reference

Sun K, Hsia N, Chen S, et al. Risk of age-related macular degeneration in patients with periodontitis: a nationwide population-based cohort study. Retina. 2020;40(12):2312–2318. doi: 10.1097/IAE.0000000000002750