PURPOSE: Although the exact pathogenesis of central serous chorioretinopathy (CSC) remains unclear, some factors are known to be sex-specific. We aimed to investigate the incidence and systemic associations for CSC in women. METHODS: This population-based nested case-control study included East Asian women whose medical claims data were obtained from the Korean National Health Insurance Service database. Patients newly diagnosed with CSC between 2017 and 2019 were assigned to the CSC group and matched to healthy controls in a 1:4 ratio by age, gender, and index date. The incidence of CSC in women and its association with gynecologic comorbidities and corticosteroid use before the index date (2008-2017) were analyzed. RESULTS: The study matched 3,789 patients with CSC with 15,156 controls. The 3-year cumulative incidence of CSC in women was 27.13 (95% confidence interval [CI], 27.06-27.19) per 100,000 people. Multivariate logistic analysis showed a significantly increased association of CSC in patients with pre-eclampsia (adjusted odds ratio, 2.66
95% CI, 1.86-3.81) (P <
0.001), endometriosis (adjusted odds ratio, 1.19
95% CI, 1.03-1.38) (P <
0.001), steroid injections alone (adjusted odds ratio, 1.29
95% CI, 1.16-1.43) (P <
0.001), and combination use of oral and injected steroid (adjusted odds ratio, 1.34
95% CI, 1.23-1.47) (P <
0.001) compared with the controls. CONCLUSION: This study provides nationwide population-based data on the incidence of CSC in Asian women and suggests that exposure to specific gynecological comorbidities and intensive corticosteroid use are associated with the development of CSC in women.