(B14) Risk of Ischemic or Hemorrhagic Retinopathy and Anticholinergic Burden in Elderly Patient in Taiwan: A Case-Crossover Study

Publication Number: 626

Background: Anticholinergic burden has grown in importance as Taiwan has progressed into an aged society, which has also resulted in elevation of the medical expenses. In addition, current studies indicated that the dysregulation of parasympathetic system and immunomodulation due to anticholinergic effect might have negative impact on cardiovascular system. We hypothesized that such dysregulated effect could influence intraocular vessels and correlate to ischemic or hemorrhagic retinopathy. Therefore, to both improve public medical quality and reduce medical cost, The study aimed to investigate the association between anticholinergic burden and ischemic or hemorrhagic retinopathy.

Objectives: To evaluate the association between anticholinergic burden and ischemic or hemorrhagic retinopathy in the Taiwan population.

Methods: We applied the case-crossover design to adjust unmeasured confounding within individuals. The individuals enrolled in Taiwan's National Health Insurance Research Database (NHID) from 2009 to 2018 were included. We identified the elder patients (age ≧ 65) with new diagnoses of retinal hemorrhage (RH) (ICD-9 code: 362.81; ICD-10 code: H35) or retinal vein occlusion (RVO) (ICD-9 code: 362.30, 362.36, 362.35, 362.37; ICD-10 code: H34.9, H34.8, H34.0). The index date (day0) was defined as the date of the first RH or RVO diagnosis. The hazard period and washout period were, respectively, defined as within 30 days (day-30 to day0) and between the 30th to 60th days (day-60 to day-30) prior to the index date. The day-180 to day-60 was divided into 4 periods (with 30 days for each), and randomly selected one of which was defined as a reference period for each individual. The baseline period was within 1 year period before the index date. To quantify anticholinergic burden, 5 different score systems were used (ADS, ACB, GABS, mACB, KABS). For each, we categorized the scores into 3 groups: low (0-1 points), moderate (2-3 points), and high (4-5 points). Odds ratios (ORs) and 95% confidence intervals (CIs) between hazard period and referent period was obtained by conditional logistic regression.

Results: We identified 2,318 cases of RH or RVO, with a mean age of 77.1 years (SD 8.17) and balanced sex distribution (male: 50.6%). The ORs(95%CI) of RH or RVO from low to moderate or high burden group were listed as follow respectively: ADS, 1.096 (0.897-1.339) and 1.329 (1.052-1.679); ACB, 1.073 (0.875-1.315) and 1.268 (1.001-1.605); GABS, 1.099 (0.898-1.344) and 1.33 (1.049-1.678); mACB, 1.121 (0.915-1.372) and 1.249 (0.988-1.579); KABS, 1.144 (0.939-1.394) and 1.266 (0.985-1.626).

Conclusions: According to our study, anticholinergic burden may be associated with the risk of RH or RVO in the elderly in Taiwan, especially for those with higher anticholinergic burden.