Falls and Fractures in Patients with Geographic Atrophy: A US Claims Data Analysis

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The increased risk of falls in elderly people represents a substantial public health burden that may be compounded by impaired visual acuity. The present study aimed to assess the independent risk of incident falls and fractures in patients with geographic atrophy (GA). This retrospective, noninterventional, cohort study analyzed three US claims datasets (Optum’s de-identified Clinformatics® Data Mart Database [Clinformatics®], Merative™ MarketScan® Commercial and Medicare Databases [MarketScan], and IQVIA US PharMetrics® [PharMetrics]). Patients were defined as having at least one International Classification of Diseases, Tenth Revision code (H35.31x3, H35.31x4) for GA. A propensity score-matched control cohort, matched on age, sex, index year, and disease history, was also included. Relative risks (RRs) for incident falls, fractures, and health care resource utilization (HCRU) were calculated between GA and control cohorts. The Clinformatics®, MarketScan, and PharMetrics datasets included 44,591, 9470, and 27,428 patients with GA, respectively. Across the three databases, mean (SD) age ranged from 75.9 (8.3) to 80.5 (7.2) years, and 61% to 64% were female. The largest subgroup was patients with bilateral GA without subfoveal involvement (35–37%), followed by unilateral GA without subfoveal involvement (23–24%). Risks of falls (RR 1.16–1.36) and fractures (RR 1.17–1.29) in the 4 years following the index date were higher in patients with GA compared with controls. Patients with bilateral GA and subfoveal involvement had the most pronounced increase in risk of falls (RR 1.42–1.49) and fractures (RR 1.33–1.45). Compared to controls, patients with GA also had an increased risk for hospitalization (RR 1.18–1.27), emergency department visits (RR 1.18–1.21), nursing home or assisted living admissions (RR 1.06–1.28), and outpatient visits (RR 1.05–1.08). GA represents an independent risk factor for falls, fractures, and higher HCRU. These data reveal the substantial public health burden of GA associated with the management of falls and fractures. Age-related macular degeneration is caused by the deterioration of the macula in the eye, making it difficult to see objects in front of you and eventually causing blindness in older individuals. Some patients develop a more severe form called geographic atrophy (GA), which gets worse over time and cannot be reversed. GA can develop in one or both eyes and may or may not affect the area around the region of the eye called the fovea (subfoveal), which provides sharp vision. Falls are the leading cause of injury in older individuals in the USA, and the risk of falls increases with age. Impaired vision is also associated with an increased risk of falls in the older adult population. This study used patient data from three large US claims databases to assess GA as a risk factor for falls and fractures. Data from older patients (≥ 50 years of age) with GA were compared with a group of patients who had similar characteristics but without GA (controls). The analysis found that patients with GA were more likely to have falls or fractures during the 4 years following a GA diagnosis versus controls. Patients with GA had a higher risk of needing medical care at a medical facility or doctor’s office. Outcomes were worse in patients with more severe forms of GA. On the basis of this research, GA was found to be an independent risk factor for falls, fractures, and higher use of health care resources, which places additional burdens on patients with GA.