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- Title
Nighttime Outdoor Artificial Light and Risk of Age-Related Macular Degeneration.
- Authors
Kim, Su Hwan; Kim, Young Kook; Shin, Young In; Kang, Goneui; Kim, Seong Pyo; Lee, Hajoung; Hong, In Hwan; Chang, In Boem; Hong, Soon-Beom; Yoon, Hyung-Jin; Ha, Ahnul
- Abstract
Key Points: Question: Is exposure to outdoor artificial light at night (OALAN) associated with the occurrence of exudative age-related macular degeneration (EAMD)? Findings: In this population-based case-control study of 4078 patients newly diagnosed with EAMD and 122 340 individuals without EAMD, a positive association between higher levels of residential OALAN and the risk of developing incident EAMD was observed. The association between exposure to light and EAMD followed a nonlinear pattern, with a concave upward slope that became more pronounced at higher levels of light exposure. Meaning: These findings suggest that OALAN may be a risk factor for EAMD. This case-control study investigates the association between residential outdoor artificial light at night and the risk of incident exudative age-related macular degeneration using nationwide population-based data in South Korea. Importance: Light pollution's impact on human health is increasingly recognized, but its link to exudative age-related macular degeneration (EAMD) remains unclear. Objective: 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. Exposures: 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. Main Outcomes and Measures: 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). Results: 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]). Conclusions and Relevance: 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.
- Subjects
SOUTH Korea; LIGHTING; AERODYNAMICS; RETINAL degeneration; CONFIDENCE intervals; NOISE; CASE-control method; RISK assessment; AGING; HEALTH insurance; RESEARCH funding; DESCRIPTIVE statistics; SOCIODEMOGRAPHIC factors; DATA analysis software; COMORBIDITY; DISEASE risk factors; OLD age
- Publication
JAMA Network Open, 2024, Vol 7, Issue 1, pe2351650
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.51650