Abstract
PURPOSE: To characterize age-specific changes in the prevalence and treatment burden of neovascular AMD (nAMD) from 2014 to 2019 in a super-aged society and to assess whether comorbidities contribute to this increase. METHODS: We performed a nationwide repeated cross-sectional study using Japan's national claims database (>95% population coverage). Adults aged ≥40 years in 2014 and 2019 were included to estimate age-stratified nAMD prevalence. Treatment burden was evaluated as the total number of nAMD-related treatment claims and mean administrations among users of each agent. Diabetes, hypertension, and dyslipidemia were identified from claims. Multivariable logistic regression compared nAMD cases with controls and assessed whether comorbidity adjustment attenuated the odds of nAMD in 2019 versus 2014. RESULTS: We identified 76,125 cases in 2014 and 125,190 in 2019; age-standardized prevalence increased from 101.3 to 152.4 per 100,000. Prevalence peaked at ages 80-84 in both years but increased most steeply among those ≥75 years (62.9%). Total treatment claims increased markedly, driven primarily by aflibercept. Among users of each agent, mean administrations increased modestly. Comorbidities were associated with higher odds of nAMD, but adjusting for them did not change the higher odds of nAMD in 2019 compared with in 2014. CONCLUSIONS: Between 2014 and 2019, the prevalence and treatment burden of nAMD increased substantially in Japan, with a disproportionate rise among older age groups in a super-aged population. Comorbidities did not account for the temporal increase, suggesting that factors beyond aging and comorbidity are contributing to the growing burden.