Biomedical Research Institute, Seoul National University Hospital (SNUH), Seoul, Korea.
Department of Ophthalmology, SNUH, Seoul, Korea.
JAMA Netw Open. 2024 Jan 2;7(1):e2351650. doi: 10.1001/jamanetworkopen.2023.51650.
Light pollution's impact on human health is increasingly recognized, but its link to exudative age-related macular degeneration (EAMD) remains unclear.
To investigate the association between exposure to outdoor artificial light at night (OALAN) and the risk of incident EAMD.
DESIGN, SETTING, AND PARTICIPANTS: In this nationwide population-based case-control study, all individuals 50 years or older with newly diagnosed EAMD between January 1, 2010, and December 31, 2011, were identified with reference to the Korean National Health Insurance Service registration program database for rare and intractable diseases. Birth year- and sex-matched controls (with no EAMD diagnosis until 2020) were selected at a 1:30 ratio. Data were acquired from May 1 to December 31, 2021, and analyzed from June 1 to November 30, 2022.
Mean levels of OALAN at participants' residential addresses during 2008 and 2009 were estimated using time-varying satellite data for a composite view of persistent nighttime illumination at an approximate scale of 1 km2.
The hazard ratios (HRs) and 95% CIs of the association between residential OALAN and risk of incident EAMD were determined based on maximum likelihood estimation after adjusting for sociodemographic characteristics, comorbidities, and area-level risk factors (ie, nighttime traffic noise and particulate matter of aerodynamic diameter ≤10 μm in each participant's administrative district of residence).
A total of 126 418 participants were included in the analysis (mean [SD] age, 66.0 [7.9] years; 78 244 men [61.9%]). Of these, 4078 were patients with newly diagnosed EAMD and 122 340 were EAMD-free matched controls. In fully adjusted models, an IQR (55.8 nW/cm2/sr) increase in OALAN level was associated with an HR of 1.67 (95% CI, 1.56-1.78) for incident EAMD. The exposure-response curve demonstrated a nonlinear, concave upward slope becoming more pronounced at higher levels of light exposure (ie, at approximately 110 nW/cm2/sr). In a subgroup analysis, an IQR increase in OALAN was associated with increased risk of incident EAMD in urban areas (HR, 1.46 [95% CI, 1.33-1.61]) but not in rural areas (HR, 1.01 [95% CI, 0.84-1.22]).
In this nationwide population-based case-control study, higher levels of residential OALAN were associated with an increased risk of incident EAMD. Future studies with more detailed information on exposure, individual adaptive behaviors, and potential mediators are warranted.
光污染对人类健康的影响日益受到关注，但它与渗出性年龄相关性黄斑变性（EAMD）之间的联系仍不清楚。
研究夜间室外人工光暴露（OALAN）与新发 EAMD 风险之间的关联。
设计、设置和参与者：在这项全国范围内基于人群的病例对照研究中，所有 2010 年 1 月 1 日至 2011 年 12 月 31 日期间新诊断为 EAMD 的 50 岁及以上人群，通过参考韩国国家健康保险服务罕见和难治性疾病登记计划数据库进行识别。以 1:30 的比例选择出生年份和性别相匹配的对照者（直到 2020 年没有 EAMD 诊断）。数据于 2021 年 5 月 1 日至 12 月 31 日采集，并于 2022 年 6 月 1 日至 11 月 30 日进行分析。
使用时变卫星数据估算参与者居住地址在 2008 年和 2009 年的 OALAN 平均水平，该数据用于以近似 1km2 的规模对持续夜间照明进行综合观察。
基于最大似然估计，调整社会人口统计学特征、合并症和区域水平风险因素（即每位参与者居住地的夜间交通噪声和空气动力学直径≤10μm 的颗粒物）后，确定居住 OALAN 与新发 EAMD 风险之间的关联的危害比（HR）和 95%CI。
共纳入 126418 名参与者（平均[SD]年龄 66.0[7.9]岁；78244 名男性[61.9%]）。其中，4078 人为新诊断的 EAMD 患者，122340 人为 EAMD 无匹配对照者。在完全调整的模型中，OALAN 水平每增加一个 IQR（55.8nW/cm2/sr），新发 EAMD 的 HR 为 1.67（95%CI，1.56-1.78）。暴露反应曲线显示出非线性、向上凹的斜率，在更高的光照水平下变得更加明显（即大约在 110nW/cm2/sr）。在亚组分析中，OALAN 每增加一个 IQR 与城市地区新发 EAMD 的风险增加相关（HR，1.46[95%CI，1.33-1.61]），但与农村地区无关（HR，1.01[95%CI，0.84-1.22]）。
在这项全国范围内基于人群的病例对照研究中，较高的居住 OALAN 水平与新发 EAMD 风险增加相关。需要进行具有更详细暴露信息、个体适应行为和潜在中介因素的未来研究。
