Abstract
Background Atopic dermatitis (AD) arises from complex gene-environmental interactions, and urban exposures are increasingly linked to its pathogenesis. Objective To investigate the independent and interactive effects of urbanization-related exposures (air pollution, noise, traffic, green space) on AD incidence stratified by genetic susceptibility. Methods Within the prospective UK Biobank cohort (n=306,837), genetic risk was categorized by polygenic risk score (PRS). Associations and dose response relationships were assessed using Cox and restricted cubic spline (RCS) models. Results Moderate and high air pollution mixtures were significantly associated with a higher AD risk, showing dose-dependent relationships. Higher green space coverage was associated with lower AD risk, particularly in the high genetic risk group (HR: 0.609, 95% CI: 0.479-0.774). Noise was linked to an elevated AD risk exclusively in high genetic susceptibility, while urban residence and traffic load were associated with increased AD risk irrespective of genetic background. In a mutually adjusted multivariable model, the effects of traffic load and noise were attenuated. Limitations Restricted ancestry, indoor pollutants, and residential mobility. Conclusion Urban exposures show dose-dependent associations with AD risk. The assessment of urbanization exposure, in addition to genetic profiling, may represent a practical approach for population-level AD risk assessment and prevention.</p>