Factors Associated with Pediatric Keratoconus – A Population-Based Nested Case–Control Study

Purpose This study aimed to assess factors associated with pediatric keratoconus in a large, population-based cohort.Methods This retrospective population-based nested case–control study utilized data from “Clalit” healthcare provider, Israel’s largest. The records of patients diagnosed with keratoconus before age 18 between 2005 and 2020 were reviewed. Demographic data, socioeconomic status, smoking habits, and the presence of systemic conditions that may be linked with keratoconus were collected and analyzed. Univariable and multivariable conditional logistic regression were employed to identify the factors associated with the development of keratoconus.Results Overall, 1953 pediatric keratoconus patients with a mean age of 14.2 years of which 60.8% were male were included. There were 19,530 age-matched healthy subjects in the control group. In multivariable analysis, male gender (OR = 1.54, p < 0.001), asthma (OR = 1.41, p < 0.001), intellectual disability (OR = 2.39, p < 0.001), atopic dermatitis (OR = 1.39, p < 0.001), and allergy (OR = 1.28, p < 0.001) were significantly associated with pediatric keratoconus. Smoking (OR = 0.73, p = 0.007), middle socioeconomic status (SES) (OR = 0.71, p = 0.001), and high SES (OR = 0.57, p = 0.001) were inversely associated with pediatric keratoconus. Diabetes mellitus showed no significant association with keratoconus risk (OR = 1.01, 95% CI: 0.40–2.58, p = 0.982).Conclusion Male gender, asthma, intellectual disability, allergy, and atopic dermatitis were linked with increased risk, while smoking, middle SES, and high SES were inversely associated with pediatric keratoconus. These findings provide valuable insights into possible areas of focus for early detection and preventative interventions in high-risk populations.