Associations between Electronic Cigarettes, Smokeless Tobacco, and Age-related Macular Degeneration in the 2017 United States National Health Interview Survey.

Purpose: To investigate the association of cigarette-alternative tobacco products with age-related macular degeneration (AMD). Methods: The 2017 National Health Interview Survey, comprising epidemiologic data from a nationally representative sample of the US adult population, was queried to identify all participants who reported using electronic cigarettes (e-cigarettes) and smokeless tobacco and whether or not they had AMD. Participant characteristics were analyzed and a multivariable regression was performed to determine predictors of AMD, adjusting for age, sex, race/ethnicity, number of packs of cigarettes smoked per day, and body mass index. Results: The final analytic sample included 26 689 survey respondents, representing the US national population of 246 242 859 adults. The weighted prevalence of AMD was 1.9% (95% confidence interval [95% CI], 1.8-2.1%). Compared to those without AMD, adults with AMD were significantly older, more often female, and disproportionately non-Hispanic White (P < .0001). In adjusted models (including adjustment for number of packs of cigarettes smoked per day), the odds ratios for developing AMD were 1.49 (95% CI, 1.02 to 2.18) in adults who used smokeless tobacco products and 1.08 (95% CI, 0.73 to 1.60) in adults who used e-cigarettes, compared to those who had never used these products. Conclusions: This study identified smokeless tobacco use as a novel factor associated with AMD among a nationally representative sample, suggesting its avoidance may reduce the risk of developing AMD. Additional studies are needed to better understand the long-term effects of e-cigarettes on AMD.