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Traffic-related air pollutants increase the risk for age-related macular degeneration
  1. Kuang-Hsi Chang1,2,3,
  2. Po-Yuan Hsu4,
  3. Chun-Ju Lin5,6,
  4. Cheng-Li Lin7,
  5. Suh-Hang Hank Juo3,4,8,9,10,
  6. Chung-Ling Liang10,11,12,13
  1. 1 Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
  2. 2 General Education Center, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
  3. 3 Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
  4. 4 Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
  5. 5 Department of Ophthalmology, China Medical University Hospital, Taichung City, Taiwan
  6. 6 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
  7. 7 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
  8. 8 Institute of New Drug Development, China Medical University, Taichung, Taiwan
  9. 9 Drug Development Center, China Medical University, Taichung, Taiwan
  10. 10 Center for Myopia and Eye Disease, China Medical University Hospital, Taichung, Taiwan
  11. 11 Department of Ophthalmology, Asia University Hospital, Taichung, Taiwan
  12. 12 Department of Optometry, College of Medical and Health Science, Asia University, Taichung, Taiwan
  13. 13 Bright Eyes Clinic, Kaohsiung, Taiwan
  1. Correspondence to Professor Suh-Hang Hank Juo; hjuo{at} and Dr. Chung-Ling Liang; ling0228{at}


The aim of this study was to investigate whether ambient nitrogen dioxide (NO2) and carbon monoxide (CO) increase the risk for age-related macular degeneration (AMD). This is a longitudinal population-based study using the data on Taiwan National Health Insurance Program between year 2000 and 2010. From the nationwide dataset, we enrolled subjects aged 50 or older and the annually total NO2 and CO exposure was calculated from 1998 to 2010 for each subject. The Cox proportional hazard regression was used to estimate the HRs with adjustment for other variables. A total of 39,819 AMD-free residents were enrolled, and 1442 participants developed AMD during the 11 -year follow-up. Compared with the lowest exposure quartile, the highest quartile of each air pollutant was associated with an increased risk for AMD. The adjusted HR was 1.91 (95% CI 1.64 to 2.23, p<0.001) for the highest NO2 quartile, and was 1.84 (95% CI 1.5 to 2.15, p<0.001) for the highest CO quartile. In this study, chronic exposure to the highest quartile of ambient NO2 or CO significantly increases the risk for AMD.

  • traffic-related pollutants
  • nitrogen dioxide (NO2)
  • carbon monoxide (CO)
  • age-related macular degeneration (AMD)

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  • Contributors Conceptualization: K-HC, P-YH, S-HHJ, and C-LL; methodology: K-HC, C-JL, S-HHJ, and C-LL; formal analysis: K-HC and C-LL; investigation: all authors; writing (original draft preparation): K-HC; writing (review and editing): S-HHJ and C-LL; visualization: all authors; supervision: S-HHJ and C-LL; project administration: S-HHJ and C-LL.

  • Funding This study was supported by the grants from the Asia University-CMU Hospital intramural grant (ASIA-106-CMUH-18), Tungs' Taichung Metroharbor Hospital (TTMHH-108R0029), Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW108-TDU-B-212-133004), Taiwan Ministry of Science and Technology (MOST 107-2321-B-039-004 and MOST 106-3114-8-039-002), the “Drug Development Center, China Medical University" from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education in Taiwan.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Ethics Review Board of China Medical University and Hospital, Taiwan (CMUH-104-REC2-115).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available from the NHIRD published by Taiwan National Health Insurance Bureau. Due to the ‘Personal Information Protection Act’, data cannot be made publicly available (

  • Patient consent for publication Not required.