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A Nationwide Case-Control Study

Debra A. Street, PhD; Jonathan C. Javitt, MD, MPH; Qin Wang, MS; James M. Tielsch, PhD; Joseph K. Canner, MS; Eric B. Bass, MD, MPH; Earl P. Steinberg, MD, MPP; Cataract Patient Outcomes Research Team

Arch Ophthalmol. 1996;114(11):1407-1411.

Abstract
Objective
To evaluate the association between cataract extraction and atherosclerosis and its complications.

Design
A nationwide case-control study.

Setting and Participants
Using a 5% random sample of all Medicare beneficiaries, we analyzed Medicare claims data on 60 803 persons 65 years of age and older who underwent cataract extraction in 1986 or 1987 and a control group of 63 765 persons matched to the cases for age, race, sex, ZIP code, and reason for Medicare entitlement.

Main Outcome Measure
Atherosclerosis and atherosclerosis-related disease and procedures were defined by International Classification of Diseases, Ninth Revision, Clinical Modification, codes or by Health Care Financing Administration Common Procedure Classification System (Current Procedural Terminology) codes. The strength of evidence for atherosclerotic disease was categorized on the basis of the types of bills in the Medicare claims file.

Results
Odds of atherosclerosis-related morbidity and procedures were higher for cases than for controls. The association decreased with patient age and was strongest in beneficiaries aged 65 to 69 years (odds ratio, 1.30; 95% confidence interval, 1.13-1.48).

Conclusion
Our findings suggest that there is a weak association between a visually significant cataract requiring surgery and atherosclerosis in the younger elderly.

Author Affiliations
From the Worthen Center for Eye Care Research, Department of Ophthalmology, Georgetown University Medical Center, Washington DC (Drs Street and Javitt and Ms Wang); and Departments of International Health (Dr Tielsch) and Health Policy and Management (Drs Bass and Steinberg), Johns Hopkins School of Hygiene and Public Health, and Department of Medicine, Johns Hopkins School of Medicine (Mr Canner and Drs Bass and Steinberg), Baltimore, Md.

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