Air pollution and unintentional injury deaths in South Korea

The association between wind speed and the risk of injuries among preschool children: New insight from a sentinel-surveillance-based study

BACKGROUND

Injuries among preschool children are an important public health concern worldwide. Significant gaps remain in understanding the potential impact of wind speed on injuries among preschoolers. We aimed to clarify the association and its variation across subgroups to capture the vulnerability features.

METHODS

Using a case-crossover design and conditional logistic regression model, we compared the exposure to wind speed right before the injury events (case period) with that of control periods to determine the excess rate (ER) of injury on each of 0-3 lag days in Guangzhou, 2016-2020. Results were also stratified by sociodemographic characteristics of patients, basic characteristics of injury events, and clinical features of injuries to identify the most vulnerable subgroups of preschoolers.

RESULTS

Higher wind speed was significantly associated with an increased risk of injuries among preschoolers on lag 0, reaching an ER of 2.93 % (95 % confidence interval [CI] = 0.87, 5.03), but not on other lag days. The results of the stratified analyses showed that children under 3-year-old (3.41 %; 95 % CI = 0.36, 6.55), boys (3.66 %; 95 % CI = 1.04, 6.35), and non-locally registered children (3.65; 95 % CI = 0.02, 7.40) were more prone to wind-related injuries. Falls (2.67 %; 95 % CI = 0.11, 5.30) were the main cause of wind-related injuries, and taking transportation was the main activity when injuries occurred (13.16 %; 95 % CI = 4.45, 22.60). Additionally, injuries involving buildings/grounds/obstacles (4.69 %; 95 % CI = 1.66, 7.81) and the occurrence of sprain/strain (7.60 %; 95 % CI = 0.64, 15.04) showed a positive association with wind speed.

CONCLUSIONS

Higher wind speed was associated with a significantly elevated rate of injuries among preschoolers without delayed effects, where children under 3-year-old, boys, and non-locally registered subgroups were more susceptible to wind-related injuries. This study may provide new insights for refining the prevention measures against wind-related injuries among preschoolers.

Association Between Regional Levels of Particulate Matter and Recurrent Falls in Korea

BACKGROUND

We investigated the extent of regional disparity of recurrent falls. In addition, we examined the association between particulate matter (PM) and recurrent falls and the association between regional disparity of recurrent falls and regional PM levels.

METHOD

We used data from Korea Community Health Survey 2019 that included 204,395 participants from 237 municipal districts. The independent variables were the annual average PM10 and PM2.5 concentrations measured at the air quality measuring stations in each municipal district. The outcome variable was the experience of falls more than twice in the previous year. Multilevel analyses were conducted to estimate the association between regional PM10 and PM2.5 levels and recurrent falls.

RESULTS

The regional variation was greater in the young people than that in the older people. PM10 and PM2.5 levels were positively associated with recurrent falls after adjusting for individual and regional covariates. These associations were more evident in the older group than in the young. PM10 and PM2.5 explained 2.82% and 3.33% of the remaining regional variance in models with individual and regional confounders, respectively. These proportions were greater in the older group (PM10 and PM2.5; 4.73% and 5.27%) than those in the younger age group (PM10 and PM2.5, 0.80% and 1.39%).

CONCLUSION

PM concentration was associated with recurrent falls even after accounting for other regional variables and individual-level differences. Moreover, there were regional differences in the occurrence of falls, and the PM concentration explained a part of the gap, but the gap was explained more in the older group than in the young.

The risk of injuries during work and its association with precipitation: New insight from a sentinel-based surveillance and a case-crossover design

Background

Injuries during work are often exogenous and can be easily influenced by environmental factors, especially weather conditions. Precipitation, a crucial weather factor, has been linked to unintentional injuries, yet evidence of its effect on work-related injuries is limited. Therefore, we aimed to clarify the impact of precipitation on injuries during work as well as its variation across numerous vulnerability features.

Methods

Records on the work-related injury during 2016-2020 were obtained from four sentinel hospitals in Guangzhou, China, and were matched with the daily weather data during the same period. We applied a time-stratified case-crossover design followed by a conditional logistic regression to evaluate the association between precipitation and work-related injuries. Covariates included wind speed, sunlight, temperature, SO ₂, NO ₂, and PM _2.5. Results were also stratified by multiple factors to identify the most vulnerable subgroups.

Results

Daily precipitation was a positive predictor of work-related injuries, with each 10 mm increase in precipitation being associated with an increase of 1.57% in the rate of injuries on the same day and 1.47-1.14% increase of injuries on subsequent 3 days. The results revealed that precipitation had a higher effect on work-related injuries in winter (4.92%; 95%CI: 1.77-8.17%). The elderly (2.07%; 95%CI: 0.64-3.51%), male (1.81%; 95%CI: 0.96-2.66%) workers or those with lower educational levels (2.58%; 95%CI: 1.59-3.54%) were more likely to suffer from injuries on rainy days. There was a higher risk for work-related injuries caused by falls (2.63%; 95%CI: 0.78-4.52%) or the use of glass products (1.75%; 95%CI: 0.49-3.02%) on rainy days.

Conclusions

Precipitation was a prominent risk factor for work-related injury, and its adverse effect might endure for 3 days. Certain sub-groups of workers were more vulnerable to injuries in the rain.

Association of Air Pollution and Weather Factors with Traffic Injury Severity: A Study in Taiwan

Exposure to air pollutants may elevate the injury severity scores (ISSs) for road traffic injuries (RTIs). This multicenter cross-sectional study aimed to investigate the associations between air pollution, weather conditions, and RTI severity. This retrospective study was performed in Taiwan in 2018. The location of each road traffic accident (RTA) was used to determine the nearest air quality monitoring and weather station, and the time of each RTA was matched to the corresponding hourly air pollutant concentration and weather factors. Five multiple logistic regression models were used to compute the risk of sustaining severe injury (ISS ≥ 9). Of the 14,973 patients with RTIs, 2853 sustained severe injury. Moderate or unhealthy air quality index, higher exposure to particulate matter ≤2.5 μm in diameter, bicyclists or pedestrians, greater road width, nighttime, and higher temperature and relative humidity were significant risk factors for severe injury. Exposure to nitrogen oxide and ozone did not increase the risk. Auto occupants and scene-to-hospital time were the protective factors. Sensitivity analyses showed consistent results between air pollutants and the risk of severe injury. Poor air quality and hot and humid weather conditions were associated with severe RTIs. Active commuters were at higher risk of sustaining severe RTI.

Exposure to mine fire related particulate matter and mortality: A time series analysis from the Hazelwood Health Study

BACKGROUND

In 2014, the Morwell brown coal mine, located in the Latrobe Valley of South eastern Australia, caught fire covering nearby areas in plumes of smoke over a 6-week period.

AIMS

To investigate the association between exposure to mine fire related air pollution and the risk of mortality.

METHODS

Time series models were used to evaluate the risk of mortality during the first 30 days of the mine fire, when the smoke was most intense, and in the following six months. Associations were also investigated between mine fire related PM_2.5 and mortality.

RESULTS

During the 30-day mine fire period, there was an increased risk of death from injury in the most exposed town of Morwell, however no increased risk was observed for all-cause, cardiovascular or respiratory mortality. In the broader Latrobe Valley, males and residents aged 80 and above were at greatest risk of death from injury during the mine fire. In Morwell, during the six months after the mine fire there was an increased risk of all-cause mortality and death from Ischaemic Heart Disease (IHD). Males and residents aged 80 and above in the broader Latrobe Valley, were at increased risk of death from IHD six months after the fire.

CONCLUSIONS

Coal mine fire exposure was associated with an increase in injury deaths during the mine fire and cardiovascular deaths in the six months after the fire. These findings assist in identifying at risk groups, and improving targeted health advice for future air pollution exposures in the community.

The Air Quality Health Index and all emergency department visits

Through a variety of media formats, the Air Quality Health Index (AQHI) has served as a valuable communication tool for the general Canadian population for several years. This index, calculated and communicated to the public on an hourly basis, is designed to provide important information on the impact of air quality on health. This presentation outlines the association between AQHI values and, for the first time, all-cause emergency department (ED) visits (over one million diagnosed ED visits). It is assumed that a higher AQHI value, reflecting increased health risk, will encourage people to take steps to reduce their exposure, by limiting the duration and intensity of outdoor activity. The case-crossover methodology was used to assess the associations between the considered exposure and ED visits. The results, the estimated odds ratios, are presented as non-linear concentration-response functions. We argue that air health effects, measured as the total number of all-cause ED visits, are related to the values of the AQHI. We postulate that there are differences in this association between males and females, possibly due to gender-specific behavior and/or health conditions.

Current State of Research on the Risk of Morbidity and Mortality Associated with Air Pollution in Korea

PURPOSE

The effects of air pollution on health can vary regionally. Our goal was to comprehensively review previous epidemiological studies on air pollution and health conducted in Korea to identify future areas of potential study.

MATERIALS AND METHODS

We systematically searched all published epidemiologic studies examining the association between air pollution and occurrence of death, diseases, or symptoms in Korea. After classifying health outcomes into mortality, morbidity, and health impact, we summarized the relationship between individual air pollutants and health outcomes.

RESULTS

We analyzed a total of 27 studies that provided 104 estimates of the quantitative association between risk of mortality and exposure to air pollutants, including particulate matter with aerodynamic diameter less than 10 μm, particulate matter with aerodynamic diameter less than 2.5 μm, sulfur dioxide, nitrogen dioxide, ozone, and carbon monoxide in Korea between January 1999 and July 2018. Regarding the association with morbidity, there were 38 studies, with 98 estimates, conducted during the same period. Most studies examined the short-term effects of air pollution using a time series or case-crossover study design; only three cohort studies that examined long-term effects were found. There were four health impact studies that calculated the attributable number of deaths or disability-adjusted life years due to air pollution.

CONCLUSION

There have been many epidemiologic studies in Korea regarding air pollution and health. However, the present review shows that additional studies, especially cohort and experimental studies, are needed to provide more robust and accurate evidence that can be used to promote evidence-based policymaking.

The relationship between airborne fine particle matter and emergency ambulance dispatches in a southwestern city in Chengdu, China

High levels of fine particulate matter (PM_2.5) are known to cause adverse effects to human health. The goal of this study was to estimate the acute health effects of short-term exposure to ambient PM_2.5 by analyzing cause-specific emergency ambulance dispatches as the endpoint in Chengdu, a city in Sichuan Province in southwest China. The ambient PM_2.5 concentration of Chengdu reached 63 μg/m³ in 2015. Data related to the causes of specific emergency ambulance dispatches, air pollution, and meteorological conditions were collected from 2013 to 2015 (1095 days). A generalized additive model (GAM) was constructed to control the confounding conditions and to estimate the effects of PM_2.5 on human health conditions. Emergency ambulance dispatches for all causes with (RR for lag0 = 1.0010, 95%CI: 1.0002, 1.0019) or without injuries (RR for lag0 = 1.0012, 95%CI: 1.0002, 1.0022), respiratory diseases (RR for lag0 = 1.0051, 95%CI: 1.0012, 1.0089), and cardiovascular diseases (RR for lag0 = 1.0041, 95%CI: 1.0009, 1.0074) were associated with ambient PM_2.5 concentrations in Chengdu. In addition, the effects of PM_2.5 were not confounded by ozone.

Fine particulate matter components and emergency department visits among a privately insured population in Greater Houston

Although adverse health effects of PM2.5 (particulate matter with aerodynamic diameter less than 2.5μm) mass have been extensively studied, it remains unclear regarding which PM2.5 components are most harmful. No studies have reported the associations between PM2.5 components and adverse health effects among a privately insured population. In our study, we estimated the short-term associations between exposure to PM2.5 components and emergency department (ED) visits for all-cause and cause-specific diseases in Greater Houston, Texas, during 2008-2013 using ED visit data extracted from a private insurance company (Blue Cross Blue Shield Texas [BCBSTX]). A total of 526,453 ED visits were included in our assessment, with an average of 236 (±63) visits per day. We selected 20 PM2.5 components from the U.S. Environmental Protection Agency's Chemical Speciation Network site located in Houston, and then applied Poisson regression models to assess the previously mentioned associations. Interquartile range increases in bromine (0.003μg/m(3)), potassium (0.048μg/m(3)), sodium ion (0.306μg/m(3)), and sulfate (1.648μg/m(3)) were statistically significantly associated with the increased risks in total ED of 0.71% (95% confidence interval (CI): 0.06, 1.37%), 0.71% (95% CI: 0.21, 1.22%), 1.28% (95% CI: 0.34, 2.24%), and 1.22% (95% CI: 0.23, 2.23%), respectively. Seasonal analysis suggested strongest associations occurred during the warm season. Our findings suggest that a privately insured population, presumably healthier than the general population, may be still at risk of adverse health effects due to exposure to ambient PM2.5 components.