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Kim Y, Oh J, Kim S, Kim A, Park J, Ahn S, Kang C, Kim S, Lee HJ, Lee JT, Lee W. Relationship between short-term ozone exposure, cause-specific mortality, and high-risk populations: A nationwide, time-stratified, case-crossover study. ENVIRONMENTAL RESEARCH 2024; 261:119712. [PMID: 39096989 DOI: 10.1016/j.envres.2024.119712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Previous studies reported that short-term exposure to ground-level ozone is associated with mortality risk. However, due to the limited monitored areas, existing studies were limited in assessing the nationwide risk and suggesting specific vulnerable populations to the ozone-mortality risk. METHODS We performed a nationwide time-stratified case-crossover study to evaluate the association between short-term ozone and cause-specific mortality in South Korea (2015-2019). A machine learning-ensemble prediction model (a test R2 > 0.96) was used to assess the short-term ozone exposure. Stratification analysis was conducted to examine the high-risk populations, and the excess mortality due to non-compliance with the WHO guideline was also assessed. RESULTS For all-cause mortality (1,343,077 cases), the risk associated with ozone (lag0- 1) was weakly identified (odd ratio: 1.005 with 95% CI: 0.997-1.014), and the risk was prominent in mortality with circulatory system diseases. In addition, based on the point estimates, the ozone-mortality risk was higher in people aged less than 65y, and this pattern was also observed in circulatory system disease deaths and urban areas. CONCLUSIONS This study provides national estimates of mortality risks associated with short-term ozone. Results showed that the benefits of stricter air quality standards could be greater in vulnerable populations.
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Affiliation(s)
- Yejin Kim
- School of the Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic of Korea
| | - Jieun Oh
- Department of Public Health Sciences, Graduate School of Public Health, Seoul, Republic of Korea
| | - Sooyeong Kim
- School of the Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic of Korea
| | - Ayoung Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul, Republic of Korea
| | - Jinah Park
- Department of Public Health Sciences, Graduate School of Public Health, Seoul, Republic of Korea
| | - Seoyeong Ahn
- Department of Information Convergence Engineering, Pusan National University, Yangsan, Republic of Korea
| | - Cinoo Kang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul, Republic of Korea
| | - Sera Kim
- Multidisciplinary Research Center for Public Health in Complex System, Korea University, Seoul, Republic of Korea; Research and Management Center for Health Risk of Particulate Matter, Seoul, Republic of Korea
| | - Hyung Joo Lee
- Research and Management Center for Health Risk of Particulate Matter, Seoul, Republic of Korea; The Division of Environmental Science and Engineering, Pohang University of Science and Technology (POSTECH), Republic of Korea; Institute for Convergence Research and Education in Advanced Technology, Yonsei University, Republic of Korea
| | - Jong Tae Lee
- Research and Management Center for Health Risk of Particulate Matter, Seoul, Republic of Korea; School of Health Policy and Management, College of Health Sciences, Korea University, Seoul 02841, Republic of Korea
| | - Whanhee Lee
- School of the Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic of Korea; Research and Management Center for Health Risk of Particulate Matter, Seoul, Republic of Korea.
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Min J, Lee W, Kang DH, Ahn S, Kim A, Kang C, Oh J, Jang H, Ho Jo C, Oh J, Park J, Moon J, Kim S, Lee J, Kim M, Kwag Y, Ha E. Air pollution and acute kidney injury with comorbid disease: A nationwide case-crossover study in South Korea. ENVIRONMENTAL RESEARCH 2024; 260:119608. [PMID: 39002627 DOI: 10.1016/j.envres.2024.119608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/24/2024] [Accepted: 07/10/2024] [Indexed: 07/15/2024]
Abstract
Emerging evidence suggests that air pollution is a significant contributor to the global burden of kidney disease. Although acute kidney injury (AKI) is a common secondary event in ill patients, evidence regarding the association between air pollution and AKI accompanied by specific comorbidities is limited. This study aimed to estimate the association between short-term exposure to air pollution (fine particulate matter ≤2.5 μm [PM2.5] and ozone [O3]) and incident AKI by comorbid diseases using the Korea National Health Information Database (NHID). Total of 160,390 incident AKI cases, defined as an emergency department (ED) visit due to AKI, were observed within the period 2015-2021 in inland South Korea. A time-stratified case-crossover design was applied for PM2.5 and O3 individually, using a conditional logistic regression model within each case and its own control (three or four days of the same day of the week in the same month) to estimate the association between short-term air pollution exposure and ED visits due to AKI. Short-term exposure to PM2.5 and O3 was associated with ED visits due to AKI with ORs of 1.008 (95% confidence interval [CI]: 0.999, 1.017) and 1.019 (95% CI: 1.005, 1.033) for an interquartile range (IQR) increase in lag 0-1 day PM2.5 and O3 respectively, although OR for PM2.5 was marginally significant. The odds of incident AKI associated with PM2.5 was evident in conjunction with ischemic heart disease, cerebrovascular disease, gastrointestinal bleeding, and pneumonia. For O3, the estimated odds was prominent for AKI with ischemic heart disease. In addition, the comorbid disease-specific odds of AKI attributed to air pollution varied by sex and age. Our findings provide epidemiological evidence of a plausible mechanism between air pollution and incident AKI and suggest the need for personalized AKI prevention strategies attributed to air pollution.
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Affiliation(s)
- Jieun Min
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea; Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Whanhee Lee
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic of Korea
| | - Duk-Hee Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Ewha Medical Research Center, Seoul, Republic of Korea
| | - Seoyeong Ahn
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic of Korea
| | - Ayoung Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Cinoo Kang
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jongmin Oh
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), Ewha Womans University College of Medicine, Seoul, Republic of Korea; Department of Human System Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hyemin Jang
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Chor Ho Jo
- Ewha Medical Research Center, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jieun Oh
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jinah Park
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jeongmin Moon
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Sooyoung Kim
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic of Korea
| | - Jungsil Lee
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Minho Kim
- Information Department, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Youngrin Kwag
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Eunhee Ha
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea; Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Republic of Korea; Institute of Ewha-SCL for Environmental Health (IESEH), Ewha Womans University College of Medicine, Seoul, Republic of Korea.
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Byun G, Kim S, Choi Y, Kim A, Team AC, Lee JT, Bell ML. Long-term exposure to PM 2.5 and mortality in a national cohort in South Korea: effect modification by community deprivation, medical infrastructure, and greenness. BMC Public Health 2024; 24:1266. [PMID: 38720292 PMCID: PMC11080206 DOI: 10.1186/s12889-024-18752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Long-term exposure to PM2.5 has been linked to increased mortality risk. However, limited studies have examined the potential modifying effect of community-level characteristics on this association, particularly in Asian contexts. This study aimed to estimate the effects of long-term exposure to PM2.5 on mortality in South Korea and to examine whether community-level deprivation, medical infrastructure, and greenness modify these associations. METHODS We conducted a nationwide cohort study using the National Health Insurance Service-National Sample Cohort. A total of 394,701 participants aged 30 years or older in 2006 were followed until 2019. Based on modelled PM2.5 concentrations, 1 to 3-year and 5-year moving averages of PM2.5 concentrations were assigned to each participant at the district level. Time-varying Cox proportional-hazards models were used to estimate the association between PM2.5 and non-accidental, circulatory, and respiratory mortality. We further conducted stratified analysis by community-level deprivation index, medical index, and normalized difference vegetation index to represent greenness. RESULTS PM2.5 exposure, based on 5-year moving averages, was positively associated with non-accidental (Hazard ratio, HR: 1.10, 95% Confidence Interval, CI: 1.01, 1.20, per 10 µg/m3 increase) and circulatory mortality (HR: 1.22, 95% CI: 1.01, 1.47). The 1-year moving average of PM2.5 was associated with respiratory mortality (HR: 1.33, 95% CI: 1.05, 1.67). We observed higher associations between PM2.5 and mortality in communities with higher deprivation and limited medical infrastructure. Communities with higher greenness showed lower risk for circulatory mortality but higher risk for respiratory mortality in association with PM2.5. CONCLUSIONS Our study found mortality effects of long-term PM2.5 exposure and underlined the role of community-level factors in modifying these association. These findings highlight the importance of considering socio-environmental contexts in the design of air quality policies to reduce health disparities and enhance overall public health outcomes.
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Affiliation(s)
- Garam Byun
- School of the Environment, Yale University, New Haven, CT, 06511, USA
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, 02841, Republic of Korea
| | - Sera Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, 02841, Republic of Korea
| | - Yongsoo Choi
- School of the Environment, Yale University, New Haven, CT, 06511, USA
| | - Ayoung Kim
- Department of Public Health Sciences, Graduate School of Public health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - AiMS-Create Team
- Ai-Machine learning Statistics Collaborative Research Ensemble for Air pollution, Temperature, and all types of Environmental exposures, Seoul National University and Pusan National University, Seoul, Republic of Korea
| | - Jong-Tae Lee
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, 02841, Republic of Korea.
- School of Health Policy and Management, College of Health Sciences, Korea University, Hana Science Hall, 145, Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, 06511, USA
- School of Health Policy and Management, College of Health Sciences, Korea University, Hana Science Hall, 145, Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
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Kim H, Jang H, Lee W, Oh J, Lee JY, Kim MH, Lee JW, Kim HS, Lee JH, Ha EH. Association between long-term PM 2.5 exposure and risk of Kawasaki disease in children: A nationwide longitudinal cohort study. ENVIRONMENTAL RESEARCH 2024; 244:117823. [PMID: 38072109 DOI: 10.1016/j.envres.2023.117823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/06/2023] [Accepted: 11/28/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Based on previous studies suggesting air pollution as a potential risk factor for Kawasaki Disease (KD), we examined the association of long-term exposure to childhood fine particulate matter (PM2.5) with the risk of KD. METHODS We used National Health Insurance Service-National Sample Cohort data from 2002 to 2019, which included beneficiaries aged 0 years at enrollment and followed-up until the onset of KD or age 5 years. The onset of KD was defined as the first hospital visit record with a primary diagnostic code of M30.3, based on the 10th revision of the International Classification of Diseases, and with an intravenous immunoglobulin (IVIG) prescription. We assigned PM2.5 concentrations to 226 districts, based on mean annual predictions from a machine learning-based ensemble prediction model. We performed Cox proportional-hazards modeling with time-varying exposures and confounders. RESULTS We identified 134,634 individuals aged five or less at enrollment and, of these, 1220 individuals who had a KD onset and an IVIG prescription during study period. The average annual concentration of PM2.5 exposed to the entire cohort was 28.2 μg/m³ (Standard Deviation 2.9). For each 5 μg/m³ increase in annual PM2.5 concentration, the hazard ratio of KD was 1.21 (95% CI 1.05-1.39). CONCLUSIONS In this nationwide, population-based, cohort study, long-term childhood exposure to PM2.5 was associated with an increased incidence of KD in children. The study highlights plausible mechanisms for the association between PM2.5 and KD, but further studies are needed to confirm our findings.
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Affiliation(s)
- Hanna Kim
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea; Institute of Ewha-Seoul Clinical Laboratories for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea.
| | - Hyemin Jang
- Institute of Ewha-Seoul Clinical Laboratories for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea; Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, 08826, Republic of Korea.
| | - Whanhee Lee
- Institute of Ewha-Seoul Clinical Laboratories for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea; School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, 50612, Republic of Korea.
| | - Jongmin Oh
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea; Institute of Ewha-Seoul Clinical Laboratories for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea; Department of Human Systems Medicine, College of Medicine, Seoul National University, Seoul, 03080, Republic of Korea.
| | - Ji-Young Lee
- Inflammation-Cancer Microenvironment Research Center, College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea.
| | - Min-Ho Kim
- Ewha Medical Data Organization, College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea.
| | - Jung Won Lee
- Institute of Ewha-Seoul Clinical Laboratories for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea; Department of Pediatrics, College of Medicine, Ewha Womans University, 07804, Seoul, Republic of Korea.
| | - Hae Soon Kim
- Institute of Ewha-Seoul Clinical Laboratories for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea; Department of Pediatrics, College of Medicine, Ewha Womans University, 07804, Seoul, Republic of Korea.
| | - Ji Hyen Lee
- Institute of Ewha-Seoul Clinical Laboratories for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea; Department of Pediatrics, College of Medicine, Ewha Womans University, 07804, Seoul, Republic of Korea.
| | - Eun-Hee Ha
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea; Institute of Ewha-Seoul Clinical Laboratories for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul, 07804, Republic of Korea; Graduate Program in System Health Science and Engineering, Ewha Womans University, Ewha Medical Research Institute, College of Medicine, Seoul, 07804, Republic of Korea.
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Park H, Kang C, Kim H. Particulate matters (PM 2.5, PM 10) and the risk of depression among middle-aged and older population: analysis of the Korean Longitudinal Study of Aging (KLoSA), 2016-2020 in South Korea. Environ Health 2024; 23:4. [PMID: 38172858 PMCID: PMC10762940 DOI: 10.1186/s12940-023-01043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND There is a growing concern that particulate matter (PM) such as PM2.5 and PM10 has contributed to exacerbating psychological disorders, particularly depression. However, little is known about the roles of these air pollutants on depression in elderly. Therefore, this study aimed to examine the association between PM2.5 and PM10, and depression in the elderly population in South Korea. METHODS We used panel survey data, the Korean Longitudinal Study of Aging (KLoSA), administered by the Labor Institute during the study period of 2016, 2018, and 2020 covering 217 districts in South Korea (n = 7674). Annual district-specific PM2.5 and PM10 concentrations were calculated for the study period from the monthly prediction concentrations produced by a machine-learning-based ensemble model (cross-validated R2: 0.87), then linked to the people matching with year and their residential district. We constructed a generalized estimating equation (GEE) model with a logit link to identify the associations between each of the long-term PM2.5 and PM10 exposures and depression (CES-D 10) after adjusting for individual and regional factors as confounders. RESULTS In single-pollutant models, we found that long-term 10 [Formula: see text] increments in PM2.5 (OR 1.36, 95% CI 1.20-1.56) and PM10 (OR 1.19, 95% CI 1.10-1.29) were associated with an increased risk of depression in the elderly. Associations were consistent after adjusting for other air pollutants (NO2 and O3) in two-pollutant models. In addition, the impacts substantially differed by regions grouped by the tertile of the population density, for which the risks of particulate matters on depression were substantial in the middle- or high-population-density areas in contrast to the low-population-density areas. CONCLUSIONS Long-term exposure to PM2.5 and PM10 was associated with a higher risk of developing depression in elderly people. The impact was modified by the population density level of the region where they reside.
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Affiliation(s)
- Hyunkyung Park
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea
- National Evidence-Based Health Care Collaborating Agency, 400 Neungdong-Ro, Gwangjin-Gu, Seoul, 04933, Republic of Korea
| | - Cinoo Kang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Ho Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea.
- Institute of Sustainable Development, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea.
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