Potential Importance of Ozone in the Association Between Outdoor Air Pollution and Dry Eye Disease in South Korea

Importance Air pollution is an important public health concern and the ocular surface is continuously exposed to pollutants in outdoor air. Ocular surface abnormalities related to air pollution are thought to be a subtype of dry eye disease (DED). However, to date, there is no large-scale study evaluating an association between air pollution and DED that includes multiple air pollutants. Objective To investigate associations between outdoor air pollution and DED in a Korean population. Design, Setting, and Participants A population-based cross-sectional study using data on 16 824 participants in the fifth Korea National Health and Nutrition Examination Survey was conducted from January 1, 2010, to December 31, 2012. Data analysis was conducted from September 1 to 30, 2015. Dry eye disease was defined as previously diagnosed by an ophthalmologist or the presence of frequent ocular pain and discomfort. Outdoor air pollution measurements (mean annual humidity, particulate matter with aerodynamic diameter 10 ], ozone, and nitrogen dioxide levels) were collected from 283 national monitoring stations in South Korea. Main Outcomes and Measures Associations of multiple air pollutants with DED were assessed from multivariable logistic regression analyses. Sociodemographic factors and previously known factors associated with DED were applied as covariates (model 1 controlled for sociodemographic factors and model 2 controlled for sociodemographic, behavioral, and clinical factors). Results Among 16 824 participants (7104 men and 9720 women), higher ozone levels and lower humidity levels were significantly associated with symptoms and diagnosis of DED. In model 1, an increase in ozone levels of 0.003 ppm was significantly associated with symptoms and diagnosis of DED (symptoms: odds ratio [OR], 1.16; 95% CI, 1.02-1.30; P  = .04; diagnosis: OR, 1.21; 95% CI, 1.05-1.40; P  = .008), while a 5% increase in humidity levels was significantly associated with decreased symptoms and diagnoses of DED (symptoms: OR, 0.87; 95% CI, 0.77-0.98; P  = .03; diagnosis: OR, 0.86; 95% CI, 0.76-0.97; P  = .01). In model 2, an increase in ozone levels of 0.003 ppm was significantly associated with symptoms and diagnosis of DED (symptoms: OR, 1.17; 95% CI, 1.02-1.34; P  = .03; diagnosis: OR, 1.27; 95 CI, 1.09-1.48; P  = .002), while a 5% increase in humidity levels was significantly associated with decreased symptoms and diagnoses of DED (symptoms: OR, 0.88; 95% CI, 0.78-0.98; P  = .045; diagnosis: OR, 0.86; 95% CI, 0.76-0.97; P  = .02). In model 2, an increase in nitrogen dioxide of 0.003 ppm (OR, 1.12; 95% CI, 1.02-1.23 P  = .02) was also associated with diagnosis of DED. Levels of sulfur dioxide and PM 10 were not associated with symptoms or diagnosis of DED in model 1 or model 2 ( P  > .05 for each). Conclusions and Relevance Higher ozone levels and lower humidity levels were associated with DED in the Korean population, while PM 10 level was not associated with DED.