Smoking-Attributable Age-Related Macular Degeneration Vision Loss in China: 1990–2021 Trends and 2040 Projections

Purpose: This study aimed to analyze the spatiotemporal burden of vision loss due to age-related macular degeneration (AMD) attributable to smoking in China from 1990 to 2021, projecting to 2040. Methods: Based on the Global Burden of Diseases 2021 dataset, we quantified epidemiological metrics for AMD-related vision loss. Joinpoint regression identified trend turning points in the smoking-attributable AMD vision loss burden. The Autoregressive Integrated Moving Average model projected trajectories to 2040. Pearson correlation assessed associations between the Socio-demographic Index and burden indicators. Results: From 1990 to 2021, AMD-related vision loss cases surged approximately 200% (2021: 2,647,261 [95% uncertainty interval {UI}: 2,185,651–3,258,896]), whereas Years Lived with Disability (YLDs) rose 184% to 153,220 (95% UI: 105,756–212,586). Age-standardized YLDs rates slightly declined by 2.74% to 7.25 per 100,000. The contribution of smoking to age-standardized YLDs decreased by 13.7%, declining from 16.82% (95% UI: 10.80%–22.44%) in 1990 to 14.52% (95% UI: 9.12%–19.58%) in 2021. Smoking-attributable AMD vision loss YLDs increased 133.5% to 23,157 cases, although age-standardized rate dropped to 1.05 per 100,000. The burden was 5.8 times higher in males than females. Joinpoint regression identified 1995 as a significant turning point for trend changes. Despite declining standardized rates, smoking-attributable AMD YLD cases are projected to increase by 38.5% by 2040 in male. Conclusions: China's burden of smoking-attributable AMD vision loss exhibits male predominance and elderly clustering. Given the vast smoking population base and accelerating demographic ageing, this burden constitutes a major public health challenge. Translational Relevance: The findings provide essential data for targeted interventions. We emphasize the crucial role of smoking cessation in AMD prevention and management.