Association of exposure to ultraviolet radiation and warm-season ozone air pollution with incident age-related macular degeneration: A nationwide cohort study in China

Background: As the leading cause of blindness, age -related macular degeneration (AMD) performs an adverse impact on human health and disability. AMD have been reported to be associated with environmental factors; however, the association between ultraviolet (UV) radiation, warm -season ambient ozone pollution, and incident AMD remains unclear. Methods: In this study, 19,707 participants without AMD at baseline were included from a nationwide longitudinal cohort in China. UV radiation and warm -season ozone exposure were evaluated through satellite -based models. Incident AMD was diagnosed via ophthalmological fundus images. Cox proportional hazard regression models were employed to explore the association of UV radiation and warm -season ozone with incident AMD, and the hazard ratios (HRs) and 95 % confidence intervals (CIs) were reported. Results: During 312,935 person -month of follow-up, 3774 participants developed to AMD. High exposure to both UV radiation and warm -season ozone was associated with increasing risk of incident AMD, with HRs and 95 % CIs of 1.32 (1.23, 1.41) and 1.20 (1.11, 1.29) in two -exposure models, respectively. Moreover, negative interaction between UV radiation and warm -season ozone was identified, and it was found that exposure to high UV radiation and low ozone presented the highest hazard for AMD. Subgroup analyses showed that the UV-AMD association was stronger in southern China, while the ozone-AMD association was greater in northern China and rural areas. Conclusion: Our study provides the first epidemiological evidence that both UV radiation and warm -season ozone would elevate the risk of incident AMD, and the hazard of higher UV radiation may be attenuated by exposure to ozone. Strategies for decreasing AMD burden should jointly consider environmental exposures and geographic locations.