Risk Factors Associated with Developing Branch Retinal Vein Occlusion Among Enrollees in a United States Managed Care Plan

• Published in: Ophthalmology (Rochester, Minn.) Vol. 121; no. 10; pp. 1939 - 1948
• Main Authors: Newman-Casey, Paula Anne, MD, MS, Stem, Maxwell, MD, Talwar, Nidhi, MA, Musch, David C., PhD, MPH, Besirli, Cagri G., MD, PhD, Stein, Joshua D., MD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2014
• Subjects: Aged; Aged, 80 and over; Female; Humans; Incidence; Male; Managed Care Programs - statistics & numerical data; Middle Aged; Multivariate Analysis; Ophthalmology; Retinal Vein Occlusion - epidemiology; Retinal Vein Occlusion - etiology; Risk Factors; United States - epidemiology; United States; CHF; open-angle glaucoma; HTN; central retinal vein occlusion; myocardial infarction; adjusted hazard ratio; DM; diabetes mellitus; International Classification of Diseases, Ninth Revision-Clinical Modification; ocular HTN; branch retinal vein occlusion; ICD-9-CM; BRVO; congestive heart failure; MI; cerebrovascular disease; aHR; peripheral arterial disease; CVA; PAD; OAG; OHTN; CRVO; HCS; hypercoagulable state; hypertension
• ISSN: 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2014.04.045

Purpose To determine risk factors associated with development of a branch retinal vein occlusion (BRVO) among a large group of managed-care plan beneficiaries in the United States. Design Retrospective, longitudinal cohort study. Participants All beneficiaries age ≥55 years continuously enrolled for ≥2 years in a managed care network from 2001–2009 who had ≥2 visits to an eye care provider. Methods Multivariable Cox regression analyses identified sociodemographic factors, ocular and nonocular conditions associated with incident BRVO. Main Outcome Measures Hazard of incident BRVO with 95% confidence interval (CI). Results Of the 492 488 enrollees who met inclusion criteria, 2283 (0.5%) developed incident BRVO. After adjustment for confounding factors, blacks (adjusted hazard ratio [aHR], 1.43; CI, 1.19–1.73; P  = 0.0001) had a 43% increased hazard of BRVO relative to non-Hispanic whites. Enrollees with hypertension (HTN) alone (aHR, 1.78; CI, 1.36–2.32; P  < 0.0001) or HTN along with other metabolic syndrome components (diabetes mellitus [DM] and hyperlipidemia; aHR, 1.44; CI, 1.12–1.84; P  = 0.005) had an increased hazard of developing a BRVO compared with those with none of these conditions. Disease severity was important; enrollees with end-organ damage caused by HTN had a 107% increased hazard of developing BRVO compared with enrollees without HTN (aHR, 2.07; CI, 1.75–2.45; P  < 0.0001). Although there was no association between DM without end-organ damage and BRVO (aHR, 0.92; CI, 0.81–1.04; P  = 0.2), individuals with end-organ damage from DM had a 36% increased hazard of BRVO (aHR, 1.36; CI, 1.18–1.57; P < 0.0001) compared with those without DM. Although cerebrovascular accident was associated with an increased hazard of developing BRVO (aHR, 1.34; CI, 1.19–1.52; P  < 0.0001), other diseases of the vascular system (deep venous thrombosis/pulmonary embolism, peripheral vascular disease, hypercoagulable state, myocardial infarction) or anticoagulant use did not increase the risk of BRVO ( P  > 0.10 for all comparisons). Conclusions Both HTN and end-organ damage from DM contribute to arteriosclerosis, atherosclerosis, and endothelial dysfunction, which seem to be major risk factors for BRVO. Ophthalmologists should emphasize to patients and their primary physicians the importance of effectively managing systemic medical conditions associated with BRVO.