Purpose
To assess the prevalence of age-related macular degeneration (AMD) in a Russian population.
Design
Population-based prevalence assessment.
Methods
The Ural Eye and Medical Study was conducted in a rural and urban area in the Russian republic of Bashkortostan. The study included 5,899 participants aged 40+ years old. AMD, defined according to the Beckman Initiative for Macular Research, was assessed by fundus photographs and optical coherence tomographic images of 4,932 (83.6%) participants.
Results
The prevalence of any AMD, early AMD, intermediate AMD, or late AMD, geographic atrophy, and neovascular AMD were 18.2% (95% confidence interval [CI], 16.8-19.6), 11.6% (95% CI, 10.4-12.8), 5.0% (95% CI, 4.2-5.8), 1.6% (95% CI, 1.1-2.0), 0.7% (95% CI, 0.4-1.0) and 0.9% (95% CI, 0.6-1.3), respectively, for individuals >55 years old. Applying an age limit of 40+ years for the AMD definition, prevalence of any AMD, early AMD, intermediate AMD, late AMD, geographic atrophy and neovascular AMD were 14.1% (95% CI, 13.1-15.1), 9.4% (95% CI, 8.6-10.2), 3.8% (95% CI, 3.2-4.3), 1.0% (95% CI, 0.7-1.2), 0.4% (95% CI, 0.2-0.6) and 0.5% (95% CI, 0.3-0.7), respectively, for individuals aged 40+ years. Higher AMD prevalence was correlated with older age (odds ratio [OR], 1.15; 95% CI, 1.13-1.16; P < 0.001), rural region (OR, 1.69; 95% CI, 1.32-2.17; P < 0.001), lower diabetes prevalence (OR, 0.56; 95% CI, 0.38-0.82; P = 0.003), and shorter axial length (OR, 0.89; 95% CI, 0.79-0.99; P = 0.04). AMD prevalence was not significantly (all P ≥ 0.20) correlated with any systemic parameter examined, except for lower prevalence of diabetes.
Conclusions
In this typical, ethnically mixed, urban and rural population from Russia, a higher prevalence for AMD was associated mainly with older age, rural region of habitation, shorter axial length, and lower prevalence of diabetes mellitus. The AMD prevalence was lower than in Europeans and higher than in East Asians.
Age-related macular degeneration (AMD) has been recognized as one of the most common causes for vision impairment and blindness worldwide. , In a recent meta-analysis of individuals 30-97 years old, the estimated pooled prevalence of early, late, and any AMD for the population aged 45-85 years old was 8.0%, 0.4%, and 8.7%, respectively. The prevalence rates were higher for individuals of European descent compared to those of Asians and Africans. In a systematic review and meta-analysis of studies with altogether close to 4 million participants, AMD with approximately 8.4 million individuals affected worldwide ranked third behind uncorrected refractive error and cataract as cause for moderate to severe vision impairment in 2015. Additionally, 5.9 million individuals were estimated to be blind due to AMD.
Despite the worldwide importance of AMD as cause for vision impairment and blindness and despite the observed interethnic and geo-epidemiological differences in the frequency of AMD, information approximately the prevalence of AMD in Russia and in East Europe or Central Asia has not been available so far, although Russia is by area is the largest and, by population, one of the largest countries worldwide. Therefore, this population-based investigation was undertaken to explore the prevalence of AMD in Russia and its association with internal medical and ocular parameters.
Subjects and Methods
The Ural Eye and Medical Study is a population-based prevalence assessment investigation that was performed in the Russian republic of Bashkortostan from 2015 to 2017. , The study was carried out in the republic’s capital Ufa and in a village area in the Karmaskalinsky District in a distance of 65 km from Ufa. The republic of Bashkortostan is located at the southwestern end of the Ural Mountains. The city of Ufa with a total population of 1.1 million inhabitants is home to Russians, Bashkirs, Tatars, Ukrainians, and other ethnicities. Inclusion criteria for the study included living in the study regions and an age of 40 years or older. The Ethics Committee of the Academic Council of the Ufa Eye Research Institute approved the study design, and all participants gave written informed consent. The study included 5,899 (80.5%) of 7,328 eligible individuals (mean age, 59.0 ± 10.7 years old; range, 40-94 years).
All study participants underwent a series of examinations, which started with a detailed interview conducted by trained social workers. The interview included more than 250 standardized questions on the participants’ socioeconomic background, smoking habits, alcohol consumption, physical activity, diet, depression and anxiety, and known diagnosis and therapy of major diseases. The examinations included anthropometry, blood pressure measurement, handgrip dynamometry, spirometry, and biochemical analysis of blood samples taken under fasting conditions. The Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) statement guidelines were applied for collecting the data. According to the new guidelines of the American Heart Association, normal blood pressure was differentiated from elevated blood pressure, stage 1 and stage 2 of arterial hypertension, and a hypertensive crisis. Diagnostic criteria for diabetes mellitus were a fasting serum glucose concentration of ≥7.0 mmol/L or a self-reported history of physician-based diagnosis or therapy of diabetes mellitus. The study design was recently described in detail. ,
The ophthalmologic examinations included automated refractometry (Auto-2Ref/Keratometer HRK-7000A, Huvitz Co, Ltd., Gyeonggi-do, Korea), determination of best corrected visual acuity, slit lamp biomicroscopy of the anterior ocular segment as performed by a fellowship-trained ophthalmologist, and noncontact tonometry. After medical mydriasis was induced (tropicamide, 0.8%, and phenylephrine, 5%, given twice in a 10-min interval), a second slit lamp examination was performed to assess the presence of pseudoexfoliation of the lens. Digital photographs of the cornea and lens were taken for the assessment of lens opacities (Topcon slit lamp and camera, Topcon Corp, Tokyo, Japan). Nuclear lens opacities were divided into 6 grades using the classifying scheme for cataract of the Age-Related Eye Disease Study. The presence of nuclear cataract grade of 3 or higher was defined. Cortical lens opacities were graded using photographs taken by retroillumination (Topcon slit lamp and camera, Topcon). The optic disc and macula were examined using digital monoscopic 60° photographs (Visucam 500; Carl Zeiss Meditec AG, Jena, Germany) and by spectral-domain optical coherence tomography (OCT) (RS-3000, Nidek Co, Ltd, Aichi Japan). The OCT scans were used to measure the peripapillary retinal nerve fiber layer thickness, the width and shape of the neuroretinal rim, the depth of the optic cup, and the thickness of the retina as a whole and divided into various retinal layers in the foveola and in the perifoveal region. The degree of fundus tessellation was examined using the fundus photographs centered on the macula and centered on the optic nerve head. Glaucoma was defined by morphological criteria as described by Foster and associates. The differentiation between open-angle glaucoma and primary angle-closure glaucoma was based on the appearance of the anterior chamber angle on the images taken with the Pentacam camera.
Age-related macular edema (AMD) was defined by using both the fundus photographs and the OCT images, as suggested by the recent Beckman Initiative for Macular Research Classification Committee and supported by previous studies. , The clinical classification system was based on fundus lesions assessed within 2 disc diameters of the fovea. Early AMD was characterized by medium-sized drusen (diameter, ≥63 to <125 μm) without pigmentary abnormalities. Intermediate AMD was defined by the presence of large drusen or by pigmentary abnormalities associated with at least medium-sized drusen. Late AMD showed either neovascular AMD or geographic atrophy. The presence of small drusen (diameter, <63 μm), also termed drupelets, was considered representative of normal aging changes. Applying the findings reported by the recent HARBOR study (Study of Ranibizumab Administered Monthly or on an As-needed Basis in Patients With Subfoveal Neovascular AMD), OCT images were used to assess and confirm the presence of drusen, subretinal fluid, subfoveal proliferation, and atrophy of the retinal pigment epithelium and retinal photoreceptors, and to differentiate such changes from other pathological abnormalities such as those found in diabetic retinopathy. An additional criterion for the diagnosis of AMD was an age of more than 55 years old. In a second step, AMD was defined with a minimum age of 40 years old. The grading of the images was performed by a group of specially trained ophthalmologists, and all images with AMD-related changes and images of all eyes with a best corrected visual acuity of less than 6 of 12 were re-checked and re-assessed by 1 of the principal investigators (J.B.J.) who adjudicated in the case of uncertainty.
Inclusion criteria for the present study were the availability of fundus photographs assessable for the presence of ophthalmoscopic features of AMD. The data were statistically analyzed by using statistical software (SPSS version 25.0; SPSS, Chicago, Illinois, for Windows; Microsoft, Redmond, Washington). From both eyes of each study participant, the eye with the worst stage of AMD was taken for the assessment of the prevalence of AMD. First, the prevalence rate of AMD (expressed as mean and 95% confidence intervals [CI]) was determined. Continuous parameters are mean ± SD. Binary univariate regression analyses were conducted of associations between the prevalence of AMD and other ocular and systemic parameters, followed by a multivariate binary regression analysis. The latter included the AMD prevalence as dependent variable and, as independent parameters, all those variables that were associated ( P ≤ 0.10) with the prevalence of AMD in the univariate analyses. In a step-by-step manner, those variables were dropped from the list of independent parameters that either showed a high collinearity or that were no longer significantly associated with the AMD prevalence. Odds ratios (OR) and 95% CI were calculated. All P values were 2-sided and considered statistically significant when the values were less than 0.05.
Results
From a population of 7,328 eligible individuals residing in the study regions and fulfilling the inclusion criterion of an age of 40+ years, 5,899 individuals (80.5%) participated in the Ural Eye and Medical Study. Comparing the data of the census carried out in 2010 in Russia and the composition of the study population did not reveal major differences in the gender and age distribution. Of the 5,899 individuals primarily participating in the Ural Eye and Medical Study, the present study consisted of 4,932 individuals (83.6%) (2,980 [60.4%] women) with available fundus photographs of sufficient quality to detect features of AMD. Reasons for unusable low quality of the fundus images were opacities of the optic media, such as dense cataract or corneal scars, insufficient cooperation of the study participants for taking the fundus photographs, or other parameters. OCT images of the macula were additionally available for more than 90% of these study participants. Their mean age was 58.5 ± 10.5 years (median, 58 years; range, 40-94 years), and their axial length was 23.3 ± 1.1 mm (median, 23.2 mm; range, 19.8-32.9 mm). The group of individuals with fundus photographs available for the assessment of AMD, compared with the group of individuals without fundus photographs, was significantly ( P < 0.001) younger (58.5 ± 10.5 years old vs 61.4 ± 11.2 years old) and had a significantly ( P < 0.001) higher proportion of women (2,980 of 4,932 or 60.4% versus 339 of 967 or 35.1%), although both groups did not differ significantly ( P = 0.09) in axial length (23.3 ± 1.1 mm vs 23.4 ± 1.8 mm).
The prevalence rate of AMD of any stage (with an age limit of >55 years old for the definition of AMD) in the total study population was 520 of 4,932 or 10.5% (95% CI, 9.7-11.4). The prevalence of early, intermediate, and late AMD stages (with an age limit of >55 years for the definition of AMD) was 331 of 4,932 (6.7%; 95% CI, 6.0-7.4), 144 of 4,932 (2.9%; 95% CI, 2.5-3.4), and 45 of 4,932 (0.9%; 95% CI, 0.7-1.2), respectively. Within the group of individuals with late AMD (n = 45), 19 eyes (0.4%; 95% CI, 0.2-0.6) showed a geographic atrophy, and 26 eyes (0.5%; 95% CI, 0.3-0.7) had neovascular AMD. The prevalence of geographic atrophy and the frequency of subfoveal neovascularization did not differ significantly ( P = 1.00). The prevalence of all stages of AMD was strongly associated with older age ( Table 1 , Figure 1 ). The prevalence of any AMD and late AMD increased from 10.2% (95% CI, 7.9-12.5) and 0.4% (95% CI, 0.0-0.9), respectively, in the age group from 55 to <60 years to 38.7% (95% CI, 31.0-46.5) and 9.0% (95% CI, 4.5-13.6) in the age group of 80+ years ( Table 1 ).
| Age Group, y | n | Early AMD | Intermediate AMD | Late AMD | Any AMD |
|---|---|---|---|---|---|
| 40 to ≤55 | 2,083 | 0 | 0 | 0 | 0 |
| >55 to <60 | 687 | 7.4% (95% CI: 5.5-9.4) (95% CI a : 5.6-9.6) | 2.3% (95% CI: 1.2-3.5) (95% CI a : 1.3-3.8) | 0.4% (95% CI: 0.0-0.9) (95% CI a : 0.1-1.3) | 10.2% (95% CI: 7.9-12.5) (95% CI a : 8.0-12.7) |
| 60 to <70 | 1,428 | 10.4% (95% CI: 8.8-12.0) (95% CI a : 8.8-12.1) | 4.5% (95% CI: 3.4-5.6) (95% CI a : 3.5-5.7) | 0.9% (95% CI: 0.4-1.4) (95% CI a : 0.5-1.6) | 15.8% (95% CI: 13.9-17.7) (95% CI a : 13.9-17.8) |
| 70 to <80 | 579 | 17.4% (95% CI: 14.3-20.5) (95% CI a : 14.4-20.8) | 8.3% (95% CI: 6.0-10.5) (95% CI a : 6.2-10.8) | 2.6% (95% CI: 1.3-3.9) (95% CI a : 1.5-4.2) | 28.3% (95% CI: 24.6-32.0) (95% CI a : 24.7-32.2) |
| 80+ | 155 | 20.0% (95% CI: 13.6-26.4) (95% CI a : 14.0-27.2) | 9.7% (95% CI: 4.5-14.4) (95% CI a : 5.5-15.5) | 9.0% (95% CI: 4.5-13.6) (95% CI a : 5.0-14.7) | 38.7% (95% CI: 31.0-46.5) (95% CI a : 31.0-46.9) |
| Total study group age 40+ | 4,932 | 6.7% (95% CI: 6.0-7.4) (95% CI a : 6.0-7.4) | 2.9% (95% CI: 2.5-3.4) (95% CI a : 2.5-3.4) | 0.9% (95% CI: 0.7-1.2) (95% CI a : 0.7-1.2) | 10.5% (95% CI: 9.7-11.4) (95% CI a : 9.7-11.4) |
| Total study group age >55 | 2,849 | 11.6% (95%CI: 10.4-12.8) (95% CI a : 105-12.9) | 5.0% (95% CI: 4.2-5.8) (95% CI a : 4.2-5.9) | 1.6% (95 CI: 1.1-2.0) (95% CI a : 1.2-2.1 | 18.2% (95% CI: 16.8-19.6) (95% CI a : 16.8-19.7) |
The prevalence rates of any AMD, early AMD, intermediate AMD, late AMD, geographic atrophy, and neovascular AMD (with an age limit of >55 years for the definition of AMD) in the study population with an age of >55 years were 18.2% (95% CI, 16.8-19.6), 11.6% (95% CI, 10.4-12.8), 5.0% (95% CI, 4.2-5.8), 1.6% (95% CI, 1.1-2.0), 0.7% (95% CI, 0.4-1.0), and 0.9% (95% CI, 0.6-1.3), respectively, for individuals aged >55 years ( Table 1 ).
Applying an age limit of 40+ years old for the definition of AMD, the prevalence rate of AMD of any stage was 695 of 4,932 or 14.1% (95% CI, 13.1-15.1). The prevalence of the early, intermediate, and late stages of AMD (with an age limit of 40+ years for the definition of AMD) was 463 of 4,932 (9.4%; 95% CI, 8.6-10.2), 185 of 4,932 (3.8%; 95% CI, 3.2-4.3), and 47 of 4,932 (1.0%; 95% CI, 0.7-1.2), respectively. Within the group of individuals with late AMD (n = 47), 21 eyes (0.4%; 95% CI, 0.2-0.6) showed a geographic atrophy, and 26 eyes (0.5%; 95% CI, 0.03-0.07) had neovascular AMD. The prevalence of geographic atrophy and the frequency of subfoveal neovascularization did not differ significantly ( P = 1.00). The prevalence of all stages of AMD was strongly associated with older age ( Table 2 ).
| Age group, y | n | Early AMD | Intermediate AMD | Late AMD | Any AMD |
|---|---|---|---|---|---|
| 40 to <50 | 1,082 | 5.1% (95% CI: 3.8-6.4) (95% CI a : 3.9-5.1) | 1.8% (95% CI: 1.0-2.7) (95% CI a : 1.1-2.8) | 0.1% (95% CI: 0.0-0.3) (95% CI a : 0.0-0.5) | 7.0% (95% CI: 5.5-8.6) (95% CI a : 5.6-8.7) |
| 50 to <60 | 1,688 | 7.6% (95% CI: 6.3-8.9) (95% CI a : 6.4-9.0) | 2.3% (95% CI: 1.5-3.0) (95% CI a : 1.6-3.1) | 0.2% (95% CI: 0.0-0.5) (95% CI a : 0.0-0.6) | 10.1% (95% CI: 8.6-11.5) (95% CI a : 8.7-11.6) |
| 60 to <70 | 1,428 | 10.4% (95% CI: 8.8-12.0) (95% CI a : 8.8-12.1) | 4.5% (95% CI: 3.4-5.6) (95% CI a : 3.5-5.7) | 0.9% (95% CI: 0.4-1.4) (95% CI a : 0.5-1.6) | 15.8% (95% CI: 13.9-17.7) (95% CI a : 13.9-17.8) |
| 70 to <80 | 579 | 17.4% (95% CI: 14.3-20.5) (95% CI a : 14.4-20.8) | 8.3% (95% CI: 6.0-10.5) (95% CI a : 6.2-10.8) | 2.6% (95% CI: 1.3-3.9) (95% CI a : 1.5-4.2) | 28.3% (95% CI: 24.6-32.0) (95% CI a : 24.7-32.2) |
| 80+ | 155 | 20.0% (95% CI: 13.6-26.4) (95% CI a : 14.0-27.2) | 9.7% (95% CI: 5.0-14.4) (95% CI a : 5.5-15.5) | 9.0% (95% CI: 4.5-13.6) (95% CI a : 5.0-14.7) | 38.7% (95% CI: 31.0-46.5) (95% CI a : 31.0-46.9) |
| Total | 4,932 | 9.4% (95% CI: 8.6-10.2) (95% CI a : 8.6-10.2) | 3.8% (95% CI: 3.2-4.3) (95% CI a : 3.2-4.3) | 1.0% (95% CI: 0.7-1.2) (95% CI a : 0.7-1.3) | 14.1% (95% CI: 13.1-15.1) (95% CI a : 13.1-15.1) |
Due to the strong association between AMD prevalence and older age and, because other factors potentially associated with AMD were also correlated with age, following binary regression analysis was adjusted for age when associations between the AMD prevalence and other parameters were tested. In that analysis, higher prevalence of AMD (age limit >55 years) was associated ( P ≤ 0.10) with the systemic (nonocular) parameters of rural region of habitation, non-Russian ethnicity, lower prevalence of a positive history of dementia and of diabetes, higher serum concentration of bilirubin and hemoglobin, lower serum concentration of glucose and lower prevalence of diabetes, a higher count of erythrocytes and leukocytes, a higher percentage of segment nuclear granulocytes, and a lower percentage of lymphocytes; and with the ocular parameters of shorter axial length ( Figure 2 ) and more myopic refractive error, smaller anterior chamber depth and volume, thicker lens, lower prevalence and degree of nuclear cataract, higher prevalence and degree of cortical cataract, lower prevalence of status after cataract surgery, glaucoma, diabetic retinopathy and myopic maculopathy ( Table 3 and 4 ). The prevalence of any AMD was not significantly ( P > 0.10) correlated with the systemic parameters of body mass index, physical activity score, smoking (package years), prevalence of any alcohol consumption, history of cardiovascular or cerebrovascular disorders, serum concentration of hepatic enzymes including the aspartate aminotransferase-to-alanine aminotransferase ratio, serum lipid concentrations, creatinine, estimated glomerular filtration rate and stage of chronic kidney disease, parameters of systemic inflammation (erythrocyte sedimentation rate, rheumatoid factor, C-reactive protein), blood pressure and arterial hypertension, subjective hearing loss, prevalence of chronic obstructive pulmonary disease, anemia, the depression score and the state-trait anxiety inventory score, and manual dynamometry ( Table 3 ). The prevalence of AMD was not associated with the ocular parameters of peripapillary retinal nerve fiber layer thickness, pseudoexfoliation of the lens, and intraocular pressure ( Table 4 ).
| Parameter | OR | 95% CI | P Value |
|---|---|---|---|
| Age, 1-y intervals | 1.12 | 1.11-1.28 | <0.001 |
| Sex, men/women | 1.01 | 0.82-1.24 | 0.94 |
| Region of habitation, urban or rural | 1.97 | 1.60-2.44 | <0.001 |
| Ethnicity, any other ethnicity/Russian | 0.69 | 0.54-0.89 | 0.004 |
| Body height, cm | 1.00 | 0.99-1.01 | 1.00 |
| Body weight, kg | 1.00 | 0.99-1.01 | 0.75 |
| Body mass index, kg/m 2 | 1.00 | 0.98-1.02 | 0.73 |
| Waist circumference, cm | 0.99 | 0.99-1.01 | 0.78 |
| Hip circumference, cm | 1.00 | 0.99-1.01 | 0.76 |
| Waist/hip circumference, ratio | 0.50 | 0.16-1.55 | 0.23 |
| Socioeconomic score | 0.97 | 0.91-1.04 | 0.37 |
| Level of education: illiteracy/passing 5th grade/8th grade/10th secondary education/postgraduate | 0.95 | 0.89-1.02 | 0.18 |
| Physical activity, score | 1.00 | 0.98-1.01 | 0.58 |
| Smoking-currently, Yes/No | 0.99 | 0.68-1.45 | 0.95 |
| Smoking-package, number years | 1.00 | 1.00-10.01 | 0.46 |
| Alcohol consumption-any, Yes/No | 0.99 | 0.75-1.29 | 0.91 |
| In a week how many days do you eat fruits? number of days | 1.00 | 0.95-1.05 | 0.93 |
| In a week how many days do you eat vegetables? number of days | 1.06 | 0.99-1.13 | 0.11 |
| History of cardiovascular disorders including stroke, Yes/No | 0.89 | 0.72-1.12 | 0.32 |
| History of angina pectoris, Yes/No | 1.13 | 0.80-1.61 | 0.48 |
| History of asthma, Yes/No | 1.15 | 0.68-1.92 | 0.61 |
| History of arthritis, Yes/No | 1.02 | 0.83-1.26 | 0.85 |
| History of previous bone fractures, Yes/No | 0.89 | 0.71-1.12 | 0.32 |
| History of low back pain, Yes/No | 0.91 | 0.74-1.12 | 0.38 |
| History of thoracic spine pain, Yes/No | 1.07 | 0.84-1.36 | 0.57 |
| History of neck pain, Yes/No | 1.12 | 0.89-1.40 | 0.33 |
| History of headache, Yes/No | 0.91 | 0.74-1.12 | 0.36 |
| History of cancer, Yes/No | 1.38 | 0.88-2.17 | 0.16 |
| History of dementia, Yes/No | 0.39 | 0.13-1.20 | 0.10 |
| History of diarrhea Yes/No, | 2.33 | 0.80-6.75 | 0.12 |
| History of iron deficiency anemia, Yes/No | 1.02 | 0.64-1.64 | 0.93 |
| History of low blood pressure and hospital admittance, Yes/No | 0.90 | 0.54-1.48 | 0.67 |
| History of osteoarthritis, Yes/No | 1.04 | 0.81-1.34 | 0.77 |
| History of skin disease, Yes/No | 0.85 | 0.54-1.35 | 0.50 |
| History of thyropathy, Yes/No | 1.03 | 0.77-1.39 | 0.84 |
| History of falls, Yes/No | 1.07 | 0.85-1.36 | 0.57 |
| History of unconsciousness, Yes/No | 0.80 | 0.56-1.14 | 0.22 |
| Age of the last menstrual bleeding, y | 1.02 | 0.99-1.05 | 0.19 |
| Age of last regular menstrual bleeding, y | 1.02 | 0.99-1.05 | 0.19 |
| History of menopause, Yes/No | 14.8 | 2.04-108 | <0.001 |
| History of diabetes mellitus, Yes/No | 0.65 | 0.46-0.93 | 0.02 |
| Alanine aminotransferase, IU/L | 1.00 | 0.99-1.01 | 0.76 |
| Aspartate aminotransferase, IU/L | 1.00 | 0.99-1.01 | 0.40 |
| Aspartate aminotransferase-to- alanine aminotransferase, ratio | 1.13 | 0.97-1.31 | 0.13 |
| Bilirubin-total, μmol/L | 1.01 | 1.00-1.02 | 0.04 |
| High-density lipoprotein, mmol/L | 1.00 | 0.89-1.13 | 0.97 |
| Low-density lipoprotein, mmol/L | 0.98 | 0.89-1.07 | 0.59 |
| Cholesterol, mmol/L | 0.99 | 0.93-1.05 | 0.69 |
| Triglycerides, mmol/L | 0.92 | 0.78-1.08 | 0.30 |
| Rheumatoid factor, IU/mL | 0.98 | 0.90-1.07 | 0.60 |
| Erythrocyte sedimentation rate, mm/min | 1.00 | 0.99-1.01 | 0.92 |
| C-reactive protein, mg/L | 1.12 | 0.81-1.53 | 0.50 |
| Glucose, mmol/L | 0.92 | 0.87-0.99 | 0.02 |
| Urea, mmol/L | 1.01 | 0.95-1.08 | 0.76 |
| Creatinine, μmol/L | 1.00 | 1.00-1.01 | 0.63 |
| Hemoglobin, g/L | 1.01 | 1.00-1.01 | 0.10 |
| Erythrocyte count, 10 6 cells/μL | 1.49 | 1.14-1.96 | 0.004 |
| Leukocyte count, 10 9 cells/L | 1.06 | 0.996-1.13 | 0.07 |
| Rod-core granulocytes, % of leukocytes | 0.97 | 0.90-1.04 | 0.36 |
| Segment nuclear granulocyte, % of leukocytes | 1.02 | 1.01-1.03 | 0.006 |
| Eosinophil granulocytes, % of leukocytes | 0.91 | 0.81-1.01 | 0.07 |
| Lymphocytes, % of leukocytes | 0.99 | 0.97,1.001 | 0.07 |
| Monocytes, % of leukocytes | 0.98 | 0.94-1.02 | 0.36 |
| Prevalence of diabetes mellitus, Yes/No | 0.56 | 0.40-0.77 | <0.001 |
| Estimated glomerular filtration rate, 30mL/min/1.73m 2 | 1.00 | 0.99-1.00 | 0.54 |
| Stage of chronic kidney disease, 0-5 | 1.00 | 0.99-1.02 | 0.94 |
| Anemia, Yes/No | 0.94 | 0.75-1.23 | 0.58 |
| Systolic blood pressure, mm Hg | 1.00 | 1.00-1.01 | 0.62 |
| Diastolic blood pressure, mm Hg | 1.00 | 0.99-1.01 | 0.49 |
| Mean blood pressure, mm Hg | 1.00 | 1.00-1.01 | 0.51 |
| Arterial hypertension Yes/No | 1.12 | 0.80-1.57 | 0.51 |
| Arterial hypertension stage, 0-4 | 1.09 | 0.98-1.20 | 0.12 |
| Prevalence of chronic obstructive pulmonary disease, Yes/No | 0.89 | 0.60-1.34 | 0.58 |
| Hearing loss, score 0-44 | 1.00 | 0.99-1.01 | 0.65 |
| Depression score, −4 to +15 | 1.01 | 0.99-1.04 | 0.42 |
| State-Trait Anxiety Inventory Score, −7 to 13 | 1.00 | 0.97-1.03 | 0.91 |
| Manual dynamometry, right hand, dekanewton | 1.00 | 0.99-1.01 | 0.99 |
| Manual dynamometry, right hand, dekanewton | 1.00 | 0.99-1.01 | 0.56 |
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