The global burden and attributable risk factor analysis of age-related macular degeneration in 204 countries and...

To report the global burden of age-related macular degeneration (AMD) and associated risk factors between 1990 and 2021 by age, sex, and sociodemographic index (SDI) and to investigate the influence of the COVID-19 pandemic on AMD burden.

Data on disability-adjusted life years (DALYs) of AMD were obtained from the Global Burden of Disease Study 2021. Joinpoint regression determined annual percentage change (APC) and average annual percentage change (AAPC). ARIMA model projected AMD burden trends, with additional analyses for frontier, decomposition, and health inequality.

Globally, AMD accounted for 578.02 (95% UI: 401.24-797.57) thousand DALYs in 2021, driven by population growth and aging. Age-standardized DALY rates (ASDRs) fell from 1990 to 2021 (AAPC: -0.69, 95%CI: -0.77 to -0.6), but increased in high-middle and middle SDI regions during the initial two years of the pandemic. ARIMA model forecasts a worldwide decline in ASDRs over the next 29 years. Sex disparities were significant, with women having continuously higher ASDRs, especially from 2019 to 2021. Despite some reduction in health inequality, an inverse SDI-ASDR relationship indicated ongoing socioeconomic disparities. Frontier analysis showed improvement potential across growth stages. Smoking-related AMD burden decreased globally, with a correlation between national ASDRs and PM_2.5 levels.

ASDRs due to AMD have decreased over the past 32 years, while DALYs have substantially increased. The burden is more heavily tilted toward women, the elderly, and less-developed countries, with COVID-19 further intensifying the situation. Addressing the burden requires focusing on smoking cessation and air quality improvements.