Expanding item 2 in Tiger Guy's good answer I'd say it's definitely about dielectric strength.
Electronic devices manufacturing standards (e.g. IEC62368-1) define creepage and clearance distances according to nominal voltage, basic or reinforced isolation need, materials and categories, aka environment where the device is supposed to be used.
The required distances are finally up-scaled according to maximum allowed altitude.
Infact Paschen's law relates dielectric withstand with atmospheric pressure.
So good manufacturers specify the choices done when designing.
https://www.powerctc.com/en/node/4757
https://en.wikipedia.org/wiki/Paschen%27s_law