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Stein JD, Pasquale LR, Talwar N, et al. Geographic and Climatic Factors Associated With Exfoliation Syndrome. Arch Ophthalmol. 2011;129(8):1053–1060. doi:10.1001/archophthalmol.2011.191
Author Affiliations: Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor (Dr Stein, Kim, Reed, and Richards and Ms Talwar); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary (Drs Pasquale and Wiggs), and Department of Medicine, Channing Laboratory, Brigham and Women's Hospital (Dr Kang), Harvard Medical School, Boston, Massachusetts; and Departments of Biostatistics (Dr Nan) and Epidemiology (Dr Richards), University of Michigan School of Public Health, Ann Arbor.
Objective To identify geographic and climatic risk factors associated with exfoliation syndrome (ES).
Methods A retrospective study of 626 901 eye care recipients, dating from 2001 to 2007 from 47 US states in a managed care network. Incident ES cases-patients (N = 3367) were identified by using billing codes. We assessed the risk of ES by geographic latitude tier in the continental United States and assigned state-level climatic data (eg, ambient temperature, elevation, and sun exposure) according to patients' residential location. The hazard of ES was calculated by using multivariable-adjusted Cox proportional hazards regression models.
Results Compared with middle-tier residence, northern-tier residence (above 42°N) was associated with an increased hazard of ES (adjusted hazard ratio [HR], 2.14; 95% confidence interval [CI], 1.94-2.35). Southern-tier (below 37°N) was associated with a reduced hazard of ES (HR, 0.83; 95% CI, 0.75-0.93). Excluding whites did not change these associations. After adjustment for joint environmental effects, for every 1° increase in July high temperature, the hazard of ES decreased by 9% (HR, 0.91; 95% CI, 0.89-0.93); for every 1° increase in January low temperature, the hazard decreased 3% (0.97; 0.96-0.98). For each additional sunny day annually, the hazard increased by 1.5% (HR, 1.02; 95% CI, 1.01-1.02) in locations with average levels of other climatic factors.
Conclusion Ambient temperature and sun exposure may be important environmental triggers of ES.
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