Smoking-Attributable Age-Related Macular Degeneration Vision Loss in China: 1990-2021 Trends and 2040 Projections

This study aimed to analyze the spatiotemporal burden of vision loss due to age-related macular degeneration (AMD) attributable to smoking in China from 1990 to 2021, projecting to 2040.

Based on the Global Burden of Diseases 2021 dataset, we quantified epidemiological metrics for AMD-related vision loss. Joinpoint regression identified trend turning points in the smoking-attributable AMD vision loss burden. The Autoregressive Integrated Moving Average model projected trajectories to 2040. Pearson correlation assessed associations between the Socio-demographic Index and burden indicators.

From 1990 to 2021, AMD-related vision loss cases surged approximately 200% (2021: 2,647,261 [95% uncertainty interval {UI}: 2,185,651-3,258,896]), whereas Years Lived with Disability (YLDs) rose 184% to 153,220 (95% UI: 105,756-212,586). Age-standardized YLDs rates slightly declined by 2.74% to 7.25 per 100,000. The contribution of smoking to age-standardized YLDs decreased by 13.7%, declining from 16.82% (95% UI: 10.80%-22.44%) in 1990 to 14.52% (95% UI: 9.12%-19.58%) in 2021. Smoking-attributable AMD vision loss YLDs increased 133.5% to 23,157 cases, although age-standardized rate dropped to 1.05 per 100,000. The burden was 5.8 times higher in males than females. Joinpoint regression identified 1995 as a significant turning point for trend changes. Despite declining standardized rates, smoking-attributable AMD YLD cases are projected to increase by 38.5% by 2040 in male.

China's burden of smoking-attributable AMD vision loss exhibits male predominance and elderly clustering. Given the vast smoking population base and accelerating demographic ageing, this burden constitutes a major public health challenge.

The findings provide essential data for targeted interventions. We emphasize the crucial role of smoking cessation in AMD prevention and management.