COVID-19 Morbidity and Severity in Patients With Age-Related Macular Degeneration: A Korean Nationwide Cohort Study

Abstract

Objective To determine the potential association of age-related macular degeneration (AMD), a representative chronic age-related degenerative disease of the retina associated with inflammation and aging, with susceptibility to SARS-CoV-2 infection and severe COVID-19 outcomes. Design Nationwide cohort study with propensity-score matching. Setting Population-based nationwide cohort in Korea. Study population Data were obtained from the Health Insurance Review & Assessment Service of Korea, including all patients older than 40 years who underwent SARS-CoV-2 testing in South Korea between January 1, 2020, and May 15, 2020 (excluding self-referral). Main outcome measures SARS-CoV-2 test positivity was the primary outcome and severe clinical outcome of COVID-19 was the secondary outcome. Results The unmatched cohort consisted of 135,435 patients who were tested for SARS-CoV-2; 4531 (3.3%) tested positive for SARS-CoV-2; 5493 (4.1%) patients had AMD. After propensity score matching, exudative AMD was associated with an increased likelihood of susceptibility to SARS-CoV-2 infection (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.03-2.25), and a considerably greater risk of severe clinical outcomes of COVID-19 (aOR, 2.26; 95% CI, 1.02 to 5.26), but not any AMD and non-exudative AMD. Conclusions In a Korean nationwide cohort, our data suggest that clinicians should be aware of the greater risk of susceptibility to severe clinical outcomes of COVID-19 in patients with exudative AMD. Our findings provide an improved understanding of the relationship between the pathogenesis of COVID-19 and chronic neurological disorders.

Adverse COVID-19 outcomes in American Veterans with age-related macular degeneration: a case–control study

“…As with AMD diagnosis, a diagnosis of severe AMD was not associated with higher rates of adverse COVID-19 outcomes after adjusting for age, CCI, sex, race, ethnicity and COVID-19 timing and using the Bonferroni correction for testing multiple outcomes. A Korean cohort study found an increased risk of adverse COVID-19 outcomes with exudative AMD (fully adjusted OR 2.26; 95% CI 1.02 to 5.26) but not non-exudative AMD 25. Our study includes more than 50 times more AMD patients with positive COVID-19 testing than the Korean cohort and similarly shows a slightly increased odds of COVID-19 hospitalisation in severe AMD; however, this result was not statistically significant after applying the Bonferroni correction.…”

“…Although these findings have prompted discussion in the ophthalmic literature,23 24 this single site New York City study included only 88 subjects with AMD. A Korean cohort study showed increased likelihood of COVID-19 susceptibility (adjusted OR 1.50; 95% CI 1.03 to 2.25) and adverse COVID-19 outcomes (adjusted OR 2.26; 95% CI 1.02 to 5.26) with exudative AMD but not non-exudative AMD 25. Because only a small percentage of subjects tested positive for COVID-19, the Korean matched cohort included only 144 COVID-19 positive AMD subjects and 33 COVID-19 positive exudative AMD subjects.…”

Propensity score matching for causal inference and reducing the confounding effects: statistical standard and guideline of Life Cycle Committee

“…This is because the P-value tends to decrease in studies with a large number of sample size. [17] Therefore, if the P-value is used and the test standard is set at 0.05, it detects the difference between the two groups more than necessary. On the other hand, since SMD is hardly affected by patients' number of sample size, SMD is used to verify the difference in covariates after propensity score matching (Fig.…”

COVID-19 and retinal degenerative diseases: Promising link “Kaempferol”

“…A disproportionate percentage of those who died were also found to be Hispanic or Black with a history of health problems such as high blood pressure, obesity, or asthma [ 2 ]. Although extra pulmonary comorbidities have gotten less attention, several studies have found connections between chronic central nervous system comorbidities and COVID-19, such as macular degeneration that causes vision loss [ 3 ].…”