{ "abstract": "Background: Visual impairment among children and adolescents is a major public health concern. However, evidence regarding the associations of PM 2.5 and its chemical constituents with incident visual impairment remains limited, particularly in highly polluted regions. We aimed to investigate these associations in northern China. Methods: This study included 12,433,993 school students from a dynamic cohort in Shandong Province, China, followed from 2012 to 2024. Annual concentrations of PM 2.5 and its five major chemical constituents were estimated using data from the Tracking Air Pollution in China database. Visual impairment was defined as visual acuity below 4.9 in either eye. Cox proportional hazards models were used to estimate associations, with penalized splines characterizing exposure–response relationships. Quantile g-computation assessed the joint association of the five constituents. Results: During 35,156,004 person-years of follow-up, 8,036,370 participants (64.6%) developed visual impairment. Each IQR increase in PM 2.5 concentration was associated with a 58% higher risk of incident visual impairment ( HR , 1.58; 95% CI , 1.53–1.63), while the five constituents were also positively associated with incident visual impairment ( HR s: 1.53–1.57). PM 2.5 and all five chemical constituents showed predominantly non-threshold linear or supra-linear exposure–response relationships. A simultaneous one-quartile increase in all five constituents was associated with a 26% higher risk of incident visual impairment ( HR , 1.26; 95% CI, 1.24–1.28). Stronger associations were consistently observed among students in higher grades. Conclusions: Our findings provide evidence of the adverse associations of PM 2.5 and its chemical constituents with visual impairment risk and emphasize the need for more rigorous regulations targeting these pollutants in China.", "abstract_shown": true, "affiliations": [ "State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao 266071, China; School of Public Health, Shandong First Medical University, Jinan 250000, China; Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China", "School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China", "State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao 266071, China; Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China", "State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao 266071, China; Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China; School of Ophthalmology, Shandong First Medical University, Jinan 250000, China", "Shandong University of Traditional Chinese Medicine, Jinan 250355, China; Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250001, China", "State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao 266071, China; School of Ophthalmology, Shandong First Medical University, Jinan 250000, China", "School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China; Corresponding author at: School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China." ], "article_type": null, "arxiv": null, "author_total": 14, "authors": [ { "affs": [ 0 ], "name": "Shanshan Li" }, { "affs": [ 1 ], "name": "Xia Meng" }, { "affs": [ 2 ], "name": "Xinhai Wang" }, { "affs": [ 1 ], "name": "Yixuan Jiang" }, { "affs": [ 3 ], "name": "Qingdong Bao" }, { "affs": [ 1 ], "name": "Yichen Liu" }, { "affs": [ 4 ], "name": "Xiao Lin" }, { "affs": [ 5 ], "name": "Xianli Du" }, { "affs": [ 3 ], "name": "Ju Zhang" }, { "affs": [ 0 ], "name": "Jianying Ma" }, { "affs": [ 3 ], "name": "Mingna Liu" }, { "name": "Lixin Xie" }, { "affs": [ 6 ], "name": "Haidong Kan" }, { "name": "Hua Gao" } ], "bibtex": "https://research.draconitic.com/paper/by6ada4gtc5z3.bib", "cited_by": 0, "doi": "10.1016/j.envint.2026.110513", "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S016041202600471X", "id": "by6ada4gtc5z3", "issns": [ "0160-4120" ], "landing_url": "https://doi.org/10.1016/j.envint.2026.110513", "language": "en", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "lcc", "GE1-350" ], [ "openalex", "2307|Air Quality and Health Impacts" ] ], "openalex": "W7212113435", "pdf_url": "https://www.sciencedirect.com/science/article/pii/S016041202600471X/pdf", "pmcid": null, "pmid": null, "published": "2026-10-24", "publisher": "Elsevier", "ris": "https://research.draconitic.com/paper/by6ada4gtc5z3.ris", "sources": [ { "first_seen": "2026-10-30T13:44:32Z", "native_id": "84035a19da354080a49d1493bd422157", "source": "doaj", "url": "https://doi.org/10.1016/j.envint.2026.110513" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2307|Air Quality and Health Impacts", "subfield": "pharmacology-toxicology" } ], "title": "Associations of long-term exposure to PM", "title_text": "Associations of long-term exposure to PM", "type": "peer-reviewed", "updated_at": "2026-10-30T13:44:32Z", "url": "https://research.draconitic.com/paper/by6ada4gtc5z3", "venue": "Environment International", "versions": [] }