Global association between ambient air pollution and age-related macular degeneration: an ecological analysis across 203 countries.

Age-related macular degeneration (AMD) is a leading cause of visual impairment worldwide, and both environmental and lifestyle factors have been implicated in its development; however, international-scale evidence regarding the impact of air pollution remains limited. We conducted a cross-sectional ecological study to evaluate national-level associations between AMD burden and environmental as well as lifestyle factors using data from the Global Burden of Disease study. Disability-adjusted life years (DALYs), age-standardized DALYs, and age-standardized prevalence of AMD from 1990 to 2020 were analyzed in relation to ambient air pollutants, including particulate matter ≤ 2.5 μm (PM2.5), PM ≤ 10 μm (PM10), nitrogen dioxide, sulfur dioxide, ozone, household air pollution from solid fuel use, and national smoking prevalence obtained from global databases. Between 1990 and 2020, global DALYs attributable to AMD increased by 26.7%, whereas age-standardized DALYs and age-standardized prevalence decreased by 19.2% and 3.4%, respectively. In 2020, age-standardized AMD prevalence showed significant positive correlations with PM2.5 (r = 0.65, p < 0.001), ozone (r = 0.55, p < 0.001), and household air pollution (r = 0.30, p < 0.001), and a significant negative correlation with smoking prevalence (r = -0.25, p < 0.001). Multivariable regression analyses identified PM2.5 (odds ratio [OR] 8.09, p < 0.001) and ozone (OR 5.42, p < 0.001) as independent predictors of AMD prevalence. These findings suggest that exposure to ambient air pollution, particularly fine particulate matter and ozone, may contribute to the global burden of AMD and represent potentially modifiable risk factors, underscoring the need for further research to clarify causal relationships and to inform public health and environmental policy interventions.