Chronic Ozone Exposure and Its Role in the Development of Age-Related Cataracts: A Comprehensive Analysis

Ambient ozone (O₃) is a potent oxidizing agent and a major contributor to the global disease burden; however, limited evidence is known about the relationship between ambient O₃ and age-related cataracts. This study aimed to investigate the potential links between long-term maximum daily 8-h mean (MDA8) O₃ and the occurrence of age-related cataracts in China. We analyzed data from 11,449 participants in the Chinese Longitudinal Healthy Longevity Survey (CLHLS), from 1998 to 2018. The fully adjusted models of Cox proportional hazards regression presented hazard ratios (HRs) for MDA8 O₃ exposure one, two, and three years prior to the end of follow-up were 1.45 [95% confidence interval (CI): 1.35, 1.57], 1.21 (95% CI: 1.13, 1.30), and 1.23 (95% CI: 1.15, 1.32), respectively. Furthermore, the association was supported by results from restricted cubic spline (RCS) models. Subgroup analyses revealed significant interactions between MDA8 O₃ and type 2 diabetes (T2D) as well as age (both P for interaction <0.05). The increased risk of age-related cataracts associated with long-term ambient O₃ exposure was more pronounced among older adults, females, individuals with lower socioeconomic status, lower educational attainment, and those with T2D.