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Purpose <p>To determine whether chronic exposure to ambient air pollutants increases the risk of blepharitis and blepharoconjunctivitis in a nationwide population.</p> Methods <p>We assembled a retrospective cohort of 552 965 adults (≥ 20&#xa0;years) in Taiwan’s National Health Insurance Research Database who were free of ocular surface disease at baseline and followed them from 2000 to 2013. Ten-year mean concentrations of sulfur dioxide (SO<sub>2</sub>), carbon monoxide (CO), particulate matter ≤ 10&#xa0;µm (PM<sub>10</sub>) and ≤ 2.5&#xa0;µm (PM<sub>2.5</sub>), nitrogen oxides (NO<sub>X</sub>), nitric oxide (NO), nitrogen dioxide (NO<sub>2</sub>), total hydrocarbons (THC), non-methane hydrocarbons (NMHC), methane (CH<sub>4</sub>), and ozone (O<sub>3</sub>) were assigned by linking residential postcodes to 76 monitoring stations. Cox proportional-hazards models estimated hazard ratios (HRs) per 1-standard deviation (SD) increase, adjusting for demographics, socioeconomic status, smoking, comorbidities, ambient temperature, season, and short-term pollutant levels.</p> Results <p>Over 6.4 million person-years, 20,752 participants developed blepharitis/blepharoconjunctivitis. Kaplan–Meier curves demonstrated progressively higher cumulative incidence across increasing tertiles of 10-year pollutant exposure (log-rank <i>P</i> &lt; 0.001). Adjusted HRs (per 1-SD) were: SO<sub>2</sub> 1.33, CO 1.98, PM<sub>10</sub> 1.76, PM<sub>2.5</sub> 1.95, NO<sub>X</sub> 1.72, NO 1.55, NO<sub>2</sub> 1.75, THC 1.90, NMHC 1.34, and CH<sub>4</sub> 2.65 (all <i>P</i> &lt; 0.001), whereas ozone was inversely associated with risk (HR 0.46). Estimates were similar in sex- and younger-age–stratified analyses.</p> Conclusion <p>Decade-long exposure to multiple common air pollutants is independently associated with a 33%–165% increase in the risk of blepharitis and blepharoconjunctivitis, while ozone showed an inverse association. These findings underscore the importance of pollution control strategies in reducing the population burden of ocular surface disease.</p>

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Chronic ambient air pollution and the incidence of blepharitis and blepharoconjunctivitis: a nationwide population-based cohort study

  • 期刊论文

  • 发表日期：

    2026年2月25日

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  • Shu-Han Chuang,
  • Yu-Pin Chen,
  • Cheng-Hsien Chang,
  • Lien-Chen Wu,
  • Yi-Jie Kuo,
  • Yu-Ling Liu

摘要

Purpose

To determine whether chronic exposure to ambient air pollutants increases the risk of blepharitis and blepharoconjunctivitis in a nationwide population.

Methods

We assembled a retrospective cohort of 552 965 adults (≥ 20 years) in Taiwan’s National Health Insurance Research Database who were free of ocular surface disease at baseline and followed them from 2000 to 2013. Ten-year mean concentrations of sulfur dioxide (SO2), carbon monoxide (CO), particulate matter ≤ 10 µm (PM10) and ≤ 2.5 µm (PM2.5), nitrogen oxides (NOX), nitric oxide (NO), nitrogen dioxide (NO2), total hydrocarbons (THC), non-methane hydrocarbons (NMHC), methane (CH4), and ozone (O3) were assigned by linking residential postcodes to 76 monitoring stations. Cox proportional-hazards models estimated hazard ratios (HRs) per 1-standard deviation (SD) increase, adjusting for demographics, socioeconomic status, smoking, comorbidities, ambient temperature, season, and short-term pollutant levels.

Results

Over 6.4 million person-years, 20,752 participants developed blepharitis/blepharoconjunctivitis. Kaplan–Meier curves demonstrated progressively higher cumulative incidence across increasing tertiles of 10-year pollutant exposure (log-rank P < 0.001). Adjusted HRs (per 1-SD) were: SO2 1.33, CO 1.98, PM10 1.76, PM2.5 1.95, NOX 1.72, NO 1.55, NO2 1.75, THC 1.90, NMHC 1.34, and CH4 2.65 (all P < 0.001), whereas ozone was inversely associated with risk (HR 0.46). Estimates were similar in sex- and younger-age–stratified analyses.

Conclusion

Decade-long exposure to multiple common air pollutants is independently associated with a 33%–165% increase in the risk of blepharitis and blepharoconjunctivitis, while ozone showed an inverse association. These findings underscore the importance of pollution control strategies in reducing the population burden of ocular surface disease.