Air Pollutant Particles, PM2.5, Exposure and Glaucoma in Patients with Diabetes: A National Population-Based Nested Case–Control Study

Abstract

The global prevalence of diabetes mellitus (DM) has reached 20%. Air pollutants with a particle size of less than 2.5 μm (PM2.5) are a globally recognized risk factor for diabetes and glaucoma. We examined whether the risk of glaucoma would decrease or increase when patients with DM were exposed to different PM2.5 concentrations. Data were obtained from the National Health Insurance Research Database (NHIRD) of Taiwan and the Air Quality Monitoring Network between 2008 and 2013. This nested case–control study involved 197 DM patients with glaucoma and 788 DM patients without glaucoma. Cases and controls were matched (1:4) by gender, age (±5 years), and index date (±6 months), and their data were entered in a logistic regression model adjusted for gender, age, urbanization level, income level, and comorbidities. The odds ratio (OR) of glaucoma at PM2.5 exposure concentration in the fourth quartile (Q4) compared with in the first quartile (Q1) was 1.7 (95% CI: 1.084–2.764). For glaucoma risk, the OR was 1.013 (95% CI: 1.006–1.020) at a PM2.5 exposure concentration in Q1, 1.004 (95% CI: 1.001–1.007) in the third quartile (Q3), and 1.003 (95% CI: 1.001–1.004) in Q4. In the subgroup analysis of patients living in non-emerging towns and non-agricultural towns, the OR for glaucoma in Q4 compared with in Q1 was 2.1 (95% CI: 1.229–3.406) and 1.8 (95% CI: 1.091–2.803), respectively (p trend = 0.001 and 0.011). For patients without migraine, the OR for glaucoma was 1.7 (95% CI: 1.074–2.782; p = 0.006). These results demonstrate that, for patients with DM, PM2.5 increased the risk of glaucoma and PM2.5 was an independent risk factor for glaucoma in patients with DM.

A Review of Ambient Air Pollution as a Risk Factor for Posterior Segment Ocular Diseases

“…Multivariable logistic regression models showed increased odds (odds ratio (OR):1.668) of developing POAG in the group exposed to WHO 2.0 Level (≥2 × 25 mg/m 3 × exposure months) compared to the normal level (<25 mg/m 3 × exposure months) [12]. A similar finding was found when the analysis was restricted to people with diabetes, with the odds of developing glaucoma in those exposed to the highest quartile of atmospheric PM 2.5 concentrations being 1.7× higher than those in the lowest quartile [13].…”

“…It was noticed that patients with comorbidities such as diabetes might have a higher risk of glaucoma when exposure to PM 2.5 is increased [13]. Likewise, children may be more susceptible to air pollution, as Min et al found that increased exposure to PM 10 is associated with an increased risk of childhood glaucoma [11].…”

“…Air pollutants' effect on posterior segment ocular diseases. Chua et al[10], Sun et al[12], Chiang et al[13], Grant et al[15] …”

Acute exposure to air pollutants increase the risk of acute glaucoma

“…A meta-analysis, which searched seven international and Chinese databases, showed significant associations of long-term or short-term exposures to ambient air pollution with blood pressure and hypertension [ 30 ]. In recent years, particulate matter pollution was related to the incidence of self-reported glaucoma or unclassified glaucoma according to the epidemiological studies [ 31 – 34 ]. And our previous studies showed mice exposed to ambient air pollutants lead to ocular hypertension [ 35 , 36 ].…”