Smoking deception and age-related macular degeneration

Smoking has been identified as a major modifiable risk factor for age-related macular degeneration (AMD). Smoking deception or failing to self-report as a smoker is a recognized concern among studies of smoking-related disease. To date, no studies have evaluated the rates of smoking deception in macular degeneration.

Data from the 2005 to 2008 National Health and Nutrition Examination Survey were used to produce estimates of smoking deception among three ethnic groups within the US population. Comparisons of self-reported rates of cigarette use, any nicotine product use, and serum cotinine levels were used to produce estimates of potential smoking deception among adults older than 40 years with any-level macular degeneration and those at risk of late-stage disease.

Any-level AMD was found to be present in 6.7% (95% confidence interval [CI] = 5.6% to 7.8%) of this cohort. Excluding those with late AMD, 9.7% (95% CI = 8.3% to 11.0%) were at risk of developing late-stage disease. Among individuals with any level of macular degeneration, 5.4% (95% CI = 2.1% to 8.6%) were potential smoking deceivers. A similar rate was seen among those at risk of late-stage disease at 5.0% (95% CI = 2.3% to 7.6%).

The rate of possible smoking deception seems higher for macular degeneration and those at risk of late-stage AMD than is generally reported in the US population. While the deception rate is low at the individual level, as many as 450,000 adults in the US population at risk of late-stage AMD may misclassify their smoking status.