Smokeless Tobacco More Likely to Cause AMD, Study Suggests

A poster presented at the American Society of Retina Specialists 2023 Annual Meeting found that smokeless tobacco was associated with a higher likelihood of having age-related macular degeneration (AMD). The study also evaluated the association between e-cigarettes and AMD.

AMD has been linked to cigarette smoking, but other forms of tobacco, such as e-cigarettes and smokeless tobacco, have been less studied in terms of their association with developing AMD. This study aimed to evaluate the relationship between e-cigarettes and smokeless tobacco and AMD in adults living in the United States.

The researchers used the adult sample of the National Health Interview Survey (NHIS), which covered topics that related to health status and utilization of care, from 2017. The primary outcome for this cross-sectional study was self-reported history of AMD, with the exposures being e-cigarette and smokeless tobacco product use. The covariates included demographic variables such as age, sex, and race, along with the number of packs of cigarettes that were smoked per day and body mass index of the participant.

There were 26,689 survey observations used in the study, which represented 246,242,859 adults in the NHIS. The researchers found that there was a weighted prevalence of 1.9% (95% CI, 1.8%-2.1%) for AMD overall. Those who had AMD were older, had lower body mass indexes, and were disproportionally non-Hispanic White.

Results showed that adults who had been exposed to e-cigarette use were more likely to develop AMD, with an unadjusted odds ratio (OR) of 0.44 (95% CI, 0.32-0.60) and an adjusted OR of 1.08 (95% CI, 0.73-1.60) compared with those who had never used e-cigarettes.

Adults who had never used smokeless tobacco were also found to be almost 10 times more likely to develop AMD compared with those who had never used smokeless tobacco in an unadjusted model (unadjusted OR, 9.96; 95% CI, 0.68-1.36), while the adjusted OR was 1.49 (95% CI, 1.02-2.18).

The researchers concluded that adults who had used e-cigarettes were not more or less likely to have AMD compared with those who had never used the products but also noted that, given the relative recency of e-cigarette use, that the full effects of e-cigarette use on AMD may not have been captured in this study alone. E-cigarette use in younger populations may prove to be an issue in the future, according to researchers. They also noted that the study is limited by the observational and cross-sectional design. However, the sample size was large, which was noted as a strength.

The researchers further concluded that people who used smokeless tobacco were more likely to develop AMD. Future studies that evaluate the relationship between e-cigarette use and other tobacco products and AMD should be conducted in the future to learn more about how the connection changes over time.

Reference

Ochoa A III, Amin SM, Loy KC, Yousuf SJ, Khan BA. Associations between electronic cigarettes, smokeless tobacco, and age-related macular degeneration in the 2017 National Health Interview Survey. Presented at: American Society of Retina Specialists Conference; July 28-Aug 1, 2023; Seattle, WA.