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Ophthalmic Epidemiology Volume 27, 2020 - Issue 5
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Research Article

Exploring Factors Underlying Ethnic Difference in Age-related Macular Degeneration Prevalence

Mark Jonesa , Hunter Medical Research Institute, Newcastle, NSW, AustraliaORCID Iconhttps://orcid.org/0000-0003-1736-1702View further author information
ORCID Icon,
Clare Whittonb Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, SingaporeView further author information
,
Ava G Tanc Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, AustraliaView further author information
,
Elizabeth G Hollidayd Centre for Clinical Epidemiology and Biostatistics, and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, AustraliaView further author information
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Christopher Oldmeadowa , Hunter Medical Research Institute, Newcastle, NSW, Australia;d Centre for Clinical Epidemiology and Biostatistics, and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, AustraliaView further author information
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Victoria M Floode School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia;f Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, AustraliaView further author information
,
Xueling Simb Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, SingaporeView further author information
,
Jin-Fang Chaib Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, SingaporeView further author information
,
Haslina Hamzahg Ocular Reading Centre, Singapore National Eye Centre, SingaporeView further author information
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Ronald Kleinh Department of Ophthalmology & Visual Sciences, University of Wisconsin Medical School, Madison, Wisconsin, USAView further author information
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Yik-Ying Teob Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, SingaporeView further author information
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Paul Mitchellc Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, AustraliaView further author information
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Tien Y Wongi Singapore Eye Research Institute, Singapore National Eye Center, Singapore;j Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, SingaporeView further author information
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E Shyong Taib Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore;k Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore;l Cardiovascular and Metabolic Disease Signature Research Program, Duke-NUS Medical School, SingaporeView further author information
,
Rob M Van Damb Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore;k Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore;m Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USAView further author information
,
John Attiaa , Hunter Medical Research Institute, Newcastle, NSW, Australia;d Centre for Clinical Epidemiology and Biostatistics, and School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, AustraliaView further author information
&
Jie Jin Wangc Centre for Vision Research, Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia;n Health Services and Systems Research, Duke-NUS Medical School, SingaporeCorrespondence[email protected] [email protected]
ORCID Iconhttps://orcid.org/0000-0001-9491-4898View further author information
ORCID Icon show all
Pages 399-408 | Received 01 Apr 2019, Accepted 24 Apr 2020, Published online: 08 Jun 2020
 
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ABSTRACT

Aims

To assess contributions of dietary and genetic factors to ethnic differences in AMD prevalence.

Design

Population-based analytical study.

Methods

In the Blue Mountains Eye Study, Australia (European ancestry n = 2826) and Multi-Ethnic Cohort Study, Singapore (Asian ancestry, n = 1900), AMD was assessed from retinal photographs. Patterns of dietary composition and scores of the Alternative Healthy Eating Index were computed using food frequency questionnaire data. Genetic susceptibility to AMD was determined using either single nucleotide polymorphisms (SNPs) of the complement factor H and age-related maculopathy susceptibility 2 genes, or combined odds-weighted genetic risk scores of 24 AMD-associated SNPs. Associations of AMD with ethnicity, diet, and genetics were assessed using logistic regression. Six potential mediators covering genetic, diet and lifestyle factors were assessed for their contributions to AMD risk difference between the two samples using mediation analyses.

Results

Age-standardized prevalence of any (early or late) AMD was higher in the European (16%) compared to Asian samples (9%, p < .01). Mean AMD-related genetic risk scores were also higher in European (33.3 ± 4.4) than Asian (Chinese) samples (31.7 ± 3.7, p < .001). In a model simultaneously adjusting for age, ethnicity, genetic susceptibility and Alternative Healthy Eating Index scores, only age and genetic susceptibility were significantly associated with AMD. Genetic risk scores contributed 19% of AMD risk difference between the two samples while intake of polyunsaturated fatty acids contributed 7.2%.

Conclusion

Genetic susceptibility to AMD was higher in European compared to Chinese samples and explained more of the AMD risk difference between the two samples than the dietary factors investigated.

Conflicts of Interest

None of the authors has any conflicts of interest to disclose, nor any financial disclosure to make.

Additional information

Funding

National Health & Medical Research Council, Australia: Project grant [ID 590204]. The sponsor or funding organization had no role in the design or conduct of this research.

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