Incidence of Retinal Artery Occlusion and Related Mortality in Korea, 2005 to 2018

Abstract

ImportanceIt remains unclear whether comorbidities in patients with retinal artery occlusion (RAO), a rare retinal vascular disorder, differ by subtype and whether mortality is higher.ObjectiveTo examine the nationwide incidence of clinically diagnosed, nonarteritic RAO, causes of death, and mortality rate in patients with RAO compared with that in the general population in Korea.Design, Setting, and ParticipantsThis retrospective, population-based cohort study examined National Health Insurance Service claims data from 2002 to 2018. The population of South Korea was 49 705 663, according to the 2015 census. Data were analyzed from February 9, 2021, to July 30, 2022.Main Outcomes and MeasuresThe nationwide incidence of any RAO, including central RAO (CRAO; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code, H34.1) and noncentral RAO (other RAO; ICD-10 code, H34.2) was estimated using National Health Insurance Service claims data from 2002 to 2018, with 2002 to 2004 as the washout period. Furthermore, the causes of death were evaluated and the standardized mortality ratio was estimated. The primary outcomes were the incidence of RAO per 100 000 person-years and the standardized mortality ratio (SMR).ResultsA total of 51 326 patients with RAO were identified (28 857 [56.2%] men; mean [SD] age at index date: 63.6 [14.1] years). The nationwide incidence of any RAO was 7.38 (95% CI, 7.32-7.44) per 100 000 person-years. The incidence rate of noncentral RAO was 5.12 (95% CI, 5.07-5.18), more than twice that of CRAO (2.25 [95% CI, 2.22-2.29]). Mortality was higher in patients with any RAO than in the general population (SMR, 7.33 [95% CI, 7.15-7.50]). The SMR for CRAO (9.95 [95% CI, 9.61-10.29]) and for noncentral RAO (5.97 [95% CI, 5.78-6.16]) showed a tendency toward a gradual decrease with increasing age. The top 3 causes of death in patients with RAO were diseases of the circulatory system (28.8%), neoplasms (25.1%), and diseases of the respiratory system (10.2%).Conclusions and RelevanceThis cohort study found that the incidence rate of noncentral RAO was higher than that of CRAO, whereas SMR was higher for CRAO than noncentral RAO. Patients with RAO show higher mortality than the general population, with circulatory system disease as the leading cause of death. These findings suggest that it is necessary to investigate the risk of cardiovascular or cerebrovascular disease in patients newly diagnosed with RAO.

Long-term Management Considerations for Retinal Artery Occlusion and Cardiovascular and Cerebrovascular Mortality

“…The study is also, to my knowledge, the first nationwide study to examine the incidence of noncentral RAO, which was comparable with that reported in other smaller studies conducted in Western countries. 1,2 The study highlights the association between RAO and elevated cardiovascular risks, which other studies have demonstrated. 3,4 The association between RAO and increased risk of developing a subsequent stroke or acute coronary syndrome has previously been reported.…”

“…Hwang et al 1 found that within the South Korean cohort between the years 2002 and 2018, 51 326 patients had RAO, of which 15 684 (30.6%) had CRAO and the remaining 35 642 (69.4%) had noncentral RAO. The incidence rate for all RAO was 7.38 (95% CI, 7.32-7.44) per 100 000 personyears, while the incidence of noncentral RAO (5.12 [95% CI, 5.07-5.18] per 100 000 person-years) was more than double that of CRAO (2.25 [95% CI, 2.22-2.29] per 100 000 person-years).…”

“…3,4 The association between RAO and increased risk of developing a subsequent stroke or acute coronary syndrome has previously been reported. 1 Studies using the Danish nationwide database have shown that risk factors connected with atherosclerosis, such as hypertension, ischemic heart disease, peripheral arterial disease, ischemic stroke, diabetes, and kidney disease, are all associated with RAO, [3][4][5] as well as glaucoma and cataracts. Moreover, atrial fibrillation (AF) was less prevalent in patients with RAO (being found in 8%), compared with the prevalence of AF in patients with stroke (13%).…”

“…In this issue of JAMA Network Open , Hwang et al report a population-based, retrospective, cohort study using the Korean National Health Insurance Service claims database to determine the incidence of retinal artery occlusion (RAO), and its associated rate (and cause) of death compared with the general population. RAO has 2 main subtypes, central RAO (CRAO) and noncentral RAO, depending on the location of the occlusion.…”

“…The study by Hwang et al adds to the growing literature surrounding associations between retinal vascular occlusion, clinical outcomes, and risk factors. Considering the inherent weaknesses from using an administrative data source, the strength of the study lies in its large sample size, providing a novel insight into the rate and causes of death in patients with RAO.…”