Abstract
Air pollution is one of the biggest public health issues, and the eye is continuously exposed to multiple outdoor air pollution. However, to date, no large-scale study has assessed the relationship between air pollutants and cataracts. We investigated associations between outdoor air pollution and cataracts in the Korean population. A population-based cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey, including 18,622 adults more than 40 years of age. The presence of cataracts and their subtypes were evaluated by ophthalmologists. Air pollution data (levels of particulate matter, ozone, nitrogen dioxide, and sulfur dioxide) for the 2 years prior to the ocular examinations were collected from national monitoring stations. The associations of multiple air pollutants with cataracts were assessed by multivariate logistic regression analyses. Sociodemographic factors and previously known risk factors for cataracts were controlled as covariates (model 1 included sociodemographic factors, sun exposure, and behavioral factors, while model 2 further included clinical factors). Higher ozone concentrations were protectively associated with overall cataract which included all subtypes [single pollutant model: 0.003 ppm increase—model 1 (OR 0.89, p = 0.014), model 2 (OR 0.87, p = 0.011); multi-pollutant model: 0.003 ppm increase—model 1 (OR 0.80, p = 0.002), model 2 (OR 0.87, p = 0.002)]. Especially, higher ozone concentrations showed deeply protective association with nuclear cataract subtype [0.003 ppm increase—single pollutant model: model 2 (OR 0.84, p = 0.006), multi-pollutant model: model 2 (OR 0.73, p < 0.001)]. Higher tropospheric ozone concentrations showed protective associations with overall cataract and nuclear cataract subtype in the Korean population.
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Acknowledgements
We thank the Epidemiologic Survey Committee of the Korean Ophthalmologic Society. The Epidemiologic Survey Committee of the Korean Ophthalmologic Society mainly participated in making and processing KNHANES data about ophthalmologic questionnaire and examinations, and helped us to access KNHANES data. We also thank Min-Jae Ju for help in accessing the Korea Census Bureau.
Financial support
This work was supported by the Gachon University Gil Medical Center (Grant number GCU-2016-5202).
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This study was approved by the Institutional Review Board of the Korea Centers for Disease Control and Prevention and complied with the tenets of the Declaration of Helsinki.
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Figure S1
Flow diagram presenting the selection of study participants. (GIF 38 kb)
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Figure S2
Yearly changes of multiple air pollution factors between 2006 and 2012 in South Korea. PM10 (μg/m3), O3, NO2, and SO2 (ppm) (GIF 13 kb)
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Figure S3
Distributed lag models between outdoor air pollutants (particulate matter, ozone, nitrogen dioxide, and sulfur dioxide) and cataracts: a) model 1, b) model 2. (multi-pollutant model). PM: particulate matter; O3: ozone, NO2: nitrogen dioxide; SO2: sulfur dioxide. Model 1: sociodemographic factors, sun exposure, and behavioral factors (age, sex, region of residence, education level, income level, sun exposure, smoking, and alcohol drinking), were included as covariates. Model 2: Aforementioned factors and clinical factors (age, sex, region of residence, education level, income level, smoking, alcohol drinking, hypertension, diabetes mellitus, hypercholesterolemia, myopia, and obesity), were included as covariates. *: Associated with cataract in multivariate logistic regression after controlling with Bonferroni’s correction (each p < 0.017) (GIF 1216 kb)
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Figure S4
Distributed lag models between ozone, nitrogen dioxide levels and nuclear cataracts in models 1 and 2: a) ozone, b) nitrogen dioxide. (multi-pollutant model). O3: ozone; NO2: nitrogen dioxide. Model 1: sociodemographic factors, sun exposure, and behavioral factors (age, sex, region of residence, education level, income level, sun exposure, smoking, and alcohol drinking), were included as covariates. Model 2: Aforementioned factors and clinical factors (age, sex, region of residence, education level, income level, smoking, alcohol drinking, hypertension, diabetes mellitus, hypercholesterolemia, myopia, and obesity), were included as covariates. *: Associated with cataract in multivariate logistic regression after controlling with Bonferroni’s correction (each p < 0.017) (GIF 679 kb)
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Choi, YH., Park, S.J., Paik, H.J. et al. Unexpected potential protective associations between outdoor air pollution and cataracts. Environ Sci Pollut Res 25, 10636–10643 (2018). https://doi.org/10.1007/s11356-018-1266-1
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DOI: https://doi.org/10.1007/s11356-018-1266-1