PURPOSE. We investigate macular perfusion and the systemic and ocular associations in a population-based setting. METHODS. In this cross-sectional study; 2018 adults residing in Hong Kong underwent detailed ophthalmic examinations after consenting to participate. Macular perfusion was measured with optical coherence tomography angiography (OCTA) using the split-spectrum amplitude decorrelation angiography algorithm. The parafoveal flow index and vessel area density were quantified using automated custom-built software. RESULTS. Of the 2018 participants, the OCFA measurements were available for 1940, and 1631 (84.1%) had good quality scans. The right eyes of these 1631 participants (43.1% men) were included for final analysis. Mean age was 49.8 years (range, 18-92 years). Mean global macular vessel density was 47.3% and 55.1% for the superficial and deep retinal layers, respectively. In multivariate analysis, lower superficial vessel density remained significantly associated with lower signal strength index (SSI; P < 0.001, standardized beta = 0.607) and male sex (P < 0.001, beta = 0.162), and borderline associated with older age (P = 0.09, beta = -0.045) and longer axial length (AL; P = 0.09, beta = -0.037), while lower deep layer vessel density was significantly associated with lower SSI (P < 0.001, standardized beta = 0.667), longer AL (P < 0.001, beta = -0.097), and higher creatinine (P < 0.001, beta = -0.072). CONCLUSIONS. This large population-based study provided normative OCTA data of macular vessel density and demonstrated that a lower superficial retinal vessel density was significantly associated with lower SSI and male sex, while a lower deep layer retinal vessel density was significantly associated with lower SSI, longer AL, and higher level of creatinine. These associations must be considered when interpreting clinical quantitative OCTA data.