1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
2
|
Kim S, Byun G, Lee JT. Association between non-optimal temperature and cardiovascular hospitalization and its temporal variation at the intersection of disability. Sci Total Environ 2023; 904:166874. [PMID: 37683874 DOI: 10.1016/j.scitotenv.2023.166874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND While previous research has identified populations susceptible to non-optimal temperatures, disability has been largely overlooked. Given the growing number of persons with disabilities (PwD) and their social and health disadvantages, understanding how disability intersects with temperature-related health effects is crucial. This study aimed to investigate the associations between non-optimal temperatures and cardiovascular disease (CVD) hospitalization and examine how these associations vary over time considering the existence of disability. METHODS We used the National Health Insurance Service-National Sample Cohort to investigate the association between non-optimal temperatures and CVD hospitalization in South Korea, 2002-2019. We obtained daily mean temperature from the Korea Meteorological Administration's automated synoptic observing system. We applied a space-time-stratified case-crossover design using a conditional quasi-Poisson regression with a distributed lag non-linear model, adjusting for relative humidity, wind speed, and public holidays. We examined temporal variations in temperature-CVD hospitalization associations using a time window approach. All analyses used the minimum hospitalization temperature (20.0 °C) as reference and were stratified by disability status. RESULTS The cumulative exposure-response curve in persons without disabilities showed a J-shape with a relative risk (RR) of 1.07 (95 % confidence interval [CI]: 0.99, 1.15) at extreme heat (99th percentile) and 1.09 (95 % CI: 0.97, 1.23) at extreme cold (1st percentile). The cumulative exposure-response curve in PwD showed an M-shape with the highest RR at chill (1.22 [95 % CI: 1.13, 1.32]) and moderate cold temperature (1.11 [95 % CI: 1.01, 1.21]), defined as the 30th and 5th percentiles, respectively. The impacts of heat and cold decreased over time for persons without disabilities but increased for PwD. CONCLUSIONS Our study found differential temperature-related impacts on CVD hospitalization based on disability status, and PwD were maladapted to heat and cold over time. This suggests the importance of considering disability when investigating temperature-related health disparity and adopting disability-inclusive adaptation strategies.
Collapse
Affiliation(s)
- Sera Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Republic of Korea
| | - Garam Byun
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Republic of Korea; School of the Environment, Yale University, New Haven, CT 06511, USA
| | - 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, Seoul 02841, Republic of Korea.
| |
Collapse
|
3
|
Shim JI, Byun G, Lee JTT. Long-term exposure to particulate matter and risk of Alzheimer's disease and vascular dementia in Korea: a national population-based Cohort Study. Environ Health 2023; 22:35. [PMID: 37060077 PMCID: PMC10105439 DOI: 10.1186/s12940-023-00986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/29/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND The prevalence of age-related neurodegenerative diseases has risen in conjunction with an increase in life expectancy. Although there is emerging evidence that air pollution might accelerate or worsen dementia progression, studies on Asian regions remains limited. This study aimed to investigate the relationship between long-term exposure to PM10 and the risk of developing Alzheimer's disease and vascular dementia in the elderly population in South Korea. METHODS The baseline population was 1.4 million people aged 65 years and above who participated in at least one national health checkup program from the National Health Insurance Service between 2008 and 2009. A nationwide retrospective cohort study was designed, and patients were followed from the date of cohort entry (January 1, 2008) to the date of dementia occurrence, death, moving residence, or the end of the study period (December 31, 2019), whichever came first. Long-term average PM10 exposure variable was constructed from national monitoring data considering time-dependent exposure. Extended Cox proportional hazard models with time-varying exposure were used to estimate hazard ratios (HR) for Alzheimer's disease and vascular dementia. RESULTS A total of 1,436,361 participants were selected, of whom 167,988 were newly diagnosed with dementia (134,811 with Alzheimer's disease and 12,215 with vascular dementia). The results show that for every 10 µg/m3 increase in PM10, the HR was 0.99 (95% CI 0.98-1.00) for Alzheimer's disease and 1.05 (95% CI 1.02-1.08) for vascular dementia. Stratified analysis according to sex and age group showed that the risk of vascular dementia was higher in men and in those under 75 years of age. CONCLUSION The results found that long-term PM10 exposure was significantly associated with the risk of developing vascular dementia but not with Alzheimer's disease. These findings suggest that the mechanism behind the PM10-dementia relationship could be linked to vascular damage.
Collapse
Affiliation(s)
- Jung-Im Shim
- College of Health Science, Korea University, Seoul, 02841, Republic of Korea.
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, 04933, Republic of Korea.
| | - Garam Byun
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, 02841, Korea
| | - Jong-Tae T Lee
- College of Health Science, Korea University, Seoul, 02841, Republic of Korea.
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, 02841, Korea.
| |
Collapse
|
4
|
Oak YJ, Park RJ, Lee JT, Byun G. Future air quality and premature mortality in Korea. Sci Total Environ 2023; 865:161134. [PMID: 36587681 DOI: 10.1016/j.scitotenv.2022.161134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/22/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
We simulate air quality in Korea for the present, the near-term, and the long-term future conditions under the Shared Socioeconomic Pathways (SSP1: most sustainable pathway with strong emissions control, SSP3: most challenging pathway with mild emissions control) using a chemical transport model. Simulated future concentrations of NO2, SO2, and fine particulate matter (PM2.5), show, in general, lower values compared to the present with varying degrees depending on SSP scenarios. Significant reductions in precursor emissions result in a decrease in O3 concentrations under a NOx-limited environment in the long-term future under SSP1. Under SSP3, O3 increases in the future under a VOC-limited regime, driven by increased CH4 levels and biogenic VOC emissions under the warming climate. Concentrations of PM2.5 and its components, including sulfate, nitrate, ammonium, and organic aerosols (OA), generally decrease in the long-term future under both scenarios. However, the contribution of biogenic secondary OA (BSOA) to PM2.5 will increase in the future. Simulated results are used to estimate cardiorespiratory mortality changes with concentration-response factors from epidemiologic studies in Korea based on national health surveys and Korean cohorts, using projected population structures from the SSP database. The cardiorespiratory health burden of long-term exposure to O3, NO2, SO2, and PM2.5 is estimated to be 10,419 (95 % confidence interval: 1271-17,142), 8630 (0-18,713), 3958 (0-9272), and 10,431 (1411-20,643) deaths in 2019. We find that the total cardiorespiratory excess mortality due to air pollutants under SSP1 decreases by 8 % and 95 % in 2045 and 2095, respectively. Under SSP3, excess mortality increases by 80 % in 2045, and decreases by 22 % in 2095, resulting in a substantial difference in the health outcomes depending on the emission scenario. We also find that the BSOA contribution to total PM2.5 will differ by region, emphasizing the potential health impact of BSOA on a local scale in the future.
Collapse
Affiliation(s)
- Yujin J Oak
- School of Earth and Environmental Sciences, Seoul National University, Seoul, South Korea
| | - Rokjin J Park
- School of Earth and Environmental Sciences, Seoul National University, Seoul, South Korea.
| | - Jong-Tae Lee
- School of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea; Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea
| | - Garam Byun
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea
| |
Collapse
|
5
|
Byun G, Choi Y, Kim S, Lee JT. Long-term exposure to ambient ozone and mortality in a population-based cohort of South Korea: Considering for an alternative exposure time metric. Environ Pollut 2022; 314:120300. [PMID: 36181930 DOI: 10.1016/j.envpol.2022.120300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
Studies on the health effects of long-term ozone exposure remain limited with mixed results. One potential source of this inconsistency is the difference in exposure time metrics. This study aimed to investigate the association between long-term exposure to ambient ozone and mortality in South Korea, using different exposure metrics. We also examined whether heterogeneity between previous studies was due to the different exposure metrics. The study population comprised 179,806 participants from the National Health Insurance Service-National Sample Cohort (2002-2015) residing in seven major cities in South Korea. Several ozone exposure metrics (year-round 24-h, year-round 8-h, warm-season 24-h, and warm-season 8-h) were calculated. Time-varying Cox proportional hazards models were used to estimate the association between ozone and all-cause and cause-specific mortalities. Random-effect meta-analysis and meta-regression analysis were performed to pool the effect estimates of previous studies and examine whether the exposure metric can explain the between-study heterogeneity. The hazard ratios (HRs) per 10 ppb increment in year-round 24-h ozone for all-cause (HR, 1.18; 95% CI, 1.07-1.29) and circulatory (HR, 1.52; 95% CI, 1.25-1.84) mortality were higher than those of the other metrics. Year-round 8-h ozone exhibited the largest association with respiratory mortality (HR, 1.43; 95% CI, 1.04-1.96). A meta-analysis of 29 previous studies and the present study showed the largest HR for all-cause mortality from studies using year-round 8-h exposure (HR, 1.014; 95% CI, 0.994-1.033). The exposure metric was significantly associated with effect estimates in the multivariable meta-regression model. In conclusion, in the population-based cohort in South Korea, we found positive associations between several long-term ozone exposure metrics and mortality. The different ozone exposure metrics exhibited heterogeneous effect estimates. A year-round 24-h average ozone metric also could be considered an alternative long-term standard for ozone.
Collapse
Affiliation(s)
- Garam Byun
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea
| | - Yongsoo Choi
- Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea
| | - Sera Kim
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea
| | - Jong-Tae Lee
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea; School of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea.
| |
Collapse
|
6
|
Choi Y, Byun G, Lee JT. The Effects of Particulate Matter Alert on Urban Park Visitation in Seoul, Korea: Using Segmented Regression. Int J Environ Res Public Health 2022; 19:15372. [PMID: 36430091 PMCID: PMC9693038 DOI: 10.3390/ijerph192215372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/17/2022] [Accepted: 11/19/2022] [Indexed: 06/16/2023]
Abstract
To reduce the health burden from particulate matter (PM), the Korean government implemented a nationwide PM10 (particles less than 10 µg/m3 in diameter) alert system in 2015. The policy was intended to reduce PM exposure by advising people to refrain from outdoor activities on highly polluted days. The present study aimed to estimate the effect of the PM10 alert system on people's daily outdoor activity patterns using urban park (specifically, Children's Grand Park) visitation data from Seoul, South Korea, from 2014-2019. Segmented regression was fitted to estimate whether the number of visitors to the park decreased on the days with PM10 alerts. PM10 concentration of 80 µg/m3, the cut-off point for a "Bad" alert, was set as a threshold, and discontinuity at the threshold and change in the relative risk after the threshold was tested. Time series regression was used to estimate the dose-response line between the ambient PM10 concentration and the daily number of park visitors. The number of park visitors decreased by 11.8% (relative risk: 0.881, 95% confidence interval: 0.808, 0.960) when a "Bad" alert was issued (PM10 level above 80 µg/m3) compared to when the alert level was "Normal" (PM10 level less than 80 µg/m3). The present study found evidence that the PM10 alert influenced people's daily outdoor activities in Seoul, Korea. As the main purpose of the PM alert is to encourage people to refrain from outdoor activities, evaluating the relationship between PM alerts and behavior patterns can help to grasp the effectiveness of the policy. Further efforts should be made to investigate whether the observed behavioral change leads to reductions in health outcomes caused by PM.
Collapse
Affiliation(s)
- Yongsoo Choi
- School of Health Policy and Management, College of Health Science, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Garam Byun
- Interdisciplinary Program in Precision Public Health, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Jong-Tae Lee
- School of Health Policy and Management, College of Health Science, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
- Interdisciplinary Program in Precision Public Health, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| |
Collapse
|
7
|
Shim JI, Byun G, Lee JT. Exposure to Particulate Matter as a Potential Risk Factor for Attention-Deficit/Hyperactivity Disorder in Korean Children and Adolescents (KNHANES 2008-2018). Int J Environ Res Public Health 2022; 19:13966. [PMID: 36360844 PMCID: PMC9656513 DOI: 10.3390/ijerph192113966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Many epidemiological studies have suggested that air pollution adversely affects neurodevelopment in children; however, evidence is still lacking. This study aimed to determine the association between particulate matter (PM) exposure and attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. Data were obtained from the Korean National Health and Nutrition Examination Survey 2008-2018. Outcomes were defined from parental reports of ever doctor-diagnosed ADHD, and ADHD cases were matched to non-cases with 1:10 age-sex matching. Individual exposure levels were assigned according to each study participant's administrative address during the year of diagnosis. Multivariate logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). After age-sex matching at a 1:10 ratio, the final study participants comprised 1,120 children aged 6-19 years old. A unit increase in the PM10 concentration was significantly associated with ADHD (OR, 1.44; 95% CI, 1.02-2.02 per 10 µg/m3). The association with ADHD was stronger at higher quartiles than in the lower quartiles of PM10 exposure; however, it was not statistically significant. Our results suggested that long-term PM10 exposure was associated with increased ADHD in children and adolescents. Children diagnosed with ADHD suffer from a variety of social activity and have a significant economic burden. Therefore, it is considered an important role to find out the effects of environmental risk factors, including air pollution, on children and adolescents. This may also help to increase the body of knowledge in this field and to stimulate further research.
Collapse
Affiliation(s)
- Jung-Im Shim
- Department of Public Health Science, Graduate School, Korea University, Seoul 02841, Korea
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul 04933, Korea
| | - Garam Byun
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea
| | - Jong-Tae Lee
- Department of Public Health Science, Graduate School, Korea University, Seoul 02841, Korea
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea
| |
Collapse
|
8
|
Choi Y, Byun G, Lee JT. Temporal Heterogeneity of Short-Term Effects of Particulate Matter on Stroke Outpatients in Seven Major Cities of the Republic of Korea. Int J Environ Res Public Health 2022; 19:12316. [PMID: 36231621 PMCID: PMC9566257 DOI: 10.3390/ijerph191912316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
Although particulate matter (PM) is a major risk factor for stroke, its effects on hospital outpatients admitted for stroke have not been documented in Korea. In addition, recent studies have reported that the effects of PM10 on circulatory mortality changed over time. We aimed to estimate the effects of PM10 on stroke and their temporal heterogeneity in seven major cities of Korea during the period 2002-2015. The study period was divided into five years of moving time windows, and city-specific PM10 effects on ischemic and hemorrhagic stroke outpatients were calculated. We pooled the estimates using meta-analysis and plotted them into a sequence to identify their temporal trends. A 10 µg/m3 increase of PM10 was significantly associated with increments in hospital outpatients admitted for ischemic stroke (0.24%, 95% CI: 0.04%, 0.44%), but not for hemorrhagic stroke (0.33%, 95% CI: -0.06%, 0.73%). Effect estimates for strokes increased during the period 2003-2013 but decreased after. For the first time, we have estimated the effects of PM10 on hospital outpatients admitted for stroke in Korea. The observed temporal trend in PM10 effects was similar to patterns of circulatory mortality, suggesting that the temporal heterogeneity in PM10 effects might be due to systematic causes rather than random fluctuations.
Collapse
Affiliation(s)
- Yongsoo Choi
- School of Health Policy and Management, College of Health Science, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02481, Korea
| | - Garam Byun
- Interdisciplinary Program in Precision Public Health, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02481, Korea
| | - Jong-Tae Lee
- School of Health Policy and Management, College of Health Science, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02481, Korea
- Interdisciplinary Program in Precision Public Health, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02481, Korea
| |
Collapse
|
9
|
Kim S, Byun G, Jo G, Park D, Cho SI, Oh H, Kim R, Subramanian SV, Yun S, Oh K, Lee JT, Shin MJ. Gender and tobacco epidemic in South Korea: implications from age-period-cohort analysis and the DPSEEA framework. BMJ Open 2022; 12:e058903. [PMID: 35414561 PMCID: PMC9006811 DOI: 10.1136/bmjopen-2021-058903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/25/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To understand a 20-year trend of gender-specific smoking prevalence among adults in South Korea. DESIGN Age-period-cohort analysis using the intrinsic estimator method was applied to examine the separate contribution of age, period and cohort effect on smoking prevalence. The Driving Force-Pressure-State-Exposure-Effect-Action (DPSEEA) framework was used to explain the observed smoking trends by mapping potential determinants and to address policy implications. SETTING General adult population in South Korea. PARTICIPANTS 34 828 men and 43 632 women who aged 19-78 years, were not currently pregnant and were without a prior diagnosis of cardiovascular disease or cancer. OUTCOME MEASURES Gender-specific current smoking prevalence using the 1998-2017 Korea National Health and Nutrition Examination Survey. RESULTS Our results showed gender-specific age and birth cohort effects. More specifically, the smoking prevalence peaked at their mid-20s (prevalence rate ratio (PRR): 1.54, 95% CI: 1.49 to 1.59) and cohort born in 1959-1963 (PRR: 1.63, 95% CI: 1.57 to 1.70) and then decreased in men. On the other hand, in women, the smoking prevalence consistently increased until their mid-40s (PRR: 1.53, 95% CI: 1.27 to 1.84) and in recent birth cohort groups (PRR in 1994-1998 cohort: 1.55, 95% CI: 1.13 to 2.13). The period effects declined from 1998-2002 to 2003-2007, following increasing fluctuations in both genders. The smoking-DPSEEA framework showed the absence of policy actions to target female smokers and emphasised a proactive approach that tackles the upstream causes for smoking in women. CONCLUSIONS Men and women are clearly in different phases of the smoking epidemic in Korean population, and gender-tailored policies should be implemented.
Collapse
Affiliation(s)
- Sera Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Garam Byun
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Garam Jo
- Division of Cardiovascular Disease Research, Department for Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju, Republic of Korea
| | - Dahyun Park
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
| | - Sung-Il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Hannah Oh
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- School of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- School of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA 02138, USA
| | - Sungha Yun
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Kyungwon Oh
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Jong-Tae Lee
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- School of Health Policy and Management, College of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Min-Jeong Shin
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- School of Biosystems and Biomedical Sciences, College of Health Science, Korea University, Seoul, Republic of Korea
| |
Collapse
|
10
|
Byun G, Kim H, Kim SY, Kim SS, Oh H, Lee JT. Validity evaluation of indirect adjustment method for multiple unmeasured confounders: A simulation and empirical study. Environ Res 2022; 204:111992. [PMID: 34487697 DOI: 10.1016/j.envres.2021.111992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND An indirect adjustment method was developed to control for unmeasured confounders in a large administrative cohort study. A previous study that proposed the indirect adjustment method assessed the validity of the method by simulations but did not consider the direction of bias and scenarios with multiple missing confounders. In this study, we evaluated the direction and the magnitude of bias of the indirect adjustment method with multiple correlated unmeasured confounders using simulation and empirical datasets. METHODS A simulation study was conducted to compare the bias of the indirect adjustment by varying the number of confounders, magnitude of correlation between confounders, and the number of adjustment variables. An empirical study was conducted by applying the indirect adjustment method to the association between PM10 and mortality using the Korea National Health and Nutrition Examination Survey linked Cause of Death data for 2007-2016. RESULTS The simulations of the present study demonstrated that 1) when a confounder is positively associated with both exposure and outcome, indirect adjustment might bias the effect size downward; 2) the magnitude of bias might depend on the correlation between unmeasured confounders; and 3) indirect adjustment for multiple missing confounders at once could result in a higher bias than that for some of the missing confounders. Empirical analyses also showed consistent results, but the bias of indirectly adjusted effect estimates was sometimes larger than that of unadjusted effect estimates. CONCLUSIONS The indirect adjustment method is a promising technique to reduce the bias from unmeasured confounding; however, it should be implemented carefully, particularly when there are multiple correlated unmeasured confounders of the same direction.
Collapse
Affiliation(s)
- Garam Byun
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea
| | - Ho Kim
- Department of Public Health Sciences, Institute of Health and Environment and Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Sun-Young Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Seung-Sup Kim
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea; School of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Hannah Oh
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea; School of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
| | - Jong-Tae Lee
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea; School of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea.
| |
Collapse
|
11
|
Kim H, Byun G, Choi Y, Kim S, Kim SY, Lee JT. Effects of long-term exposure to air pollution on all-cause mortality and cause-specific mortality in seven major cities of South Korea: Korean national health and nutritional examination surveys with mortality follow-up. Environ Res 2021; 192:110290. [PMID: 33027629 DOI: 10.1016/j.envres.2020.110290] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
Evidence from cohort studies on the effects of long-term exposure to air pollution on mortality is limited in South Korea, which has high concentration of particles compared to North America, Western Europe, and Japan, and low exposure compared to China. To reduce knowledge gaps between other countries and South Korea, we investigated the association between all-cause, cardiovascular, and respiratory mortality and long-term exposure to PM10 and, as a surrogate for fine particles from local emission sources, SO2 and NO2. Participants comprised 18,220 subjects (97,114.4 person-years) residing in 73 districts of seven major cities of South Korea who were assigned to measurements of fixed-site monitoring stations and followed up. We applied Cox proportional hazard models with time-varying exposure up to three years average of air pollutants. We adjusted for individual and district-level covariates measured at baseline such as age, sex, socioeconomic positions, and health behaviors. We found that hazard ratios of PM10 and SO2 for all-cause mortality leveled off over approximately 5 ppb of SO2 and 35-50 μg/m3 of PM10. Interquartile range increases of PM10 (5.05 μg/m3), SO2 (2.09 ppb), and NO2 (11.41 ppb) were associated with 14.4% (95% CI: -0.4, 31.4), 18.1% (-4.5, 46.0), and 18.9% (-8.7, 54.7) increases in cardiovascular mortality, respectively. We did not find positive associations for respiratory mortality. The increase in cardiovascular mortality varied by sex (for PM10, in females, 27.4% (5.8, 53.5) increase), smoking (in non-smokers, 35.9% (12.7, 64.0) increase), drinking (in drinkers, 24.5% (2.1, 51.8) increase), marital status (in those not married, 23.1% (1.1, 49.9)), employment status (for SO2, in those employed, 79.4% (16.1, 177.3) increase), body mass index (in those ≥23, 47.6% (10.4, 97.3) increase), and community deprivation (for PM10, in less deprived communities, 21.0% (1.3, 44.4) increase). In summary, long-term exposure to air pollution is associated with mortality risk in South Korea. Our results suggest that the health effect of long-term exposure to air pollution may not be equal by sex, health behaviors and socioeconomic positions.
Collapse
Affiliation(s)
- Honghyok Kim
- BK21PLUS Program in "Embodiment: Health-Society Interaction," Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Garam Byun
- BK21PLUS Program in "Embodiment: Health-Society Interaction," Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Yongsoo Choi
- BK21PLUS Program in "Embodiment: Health-Society Interaction," Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Sera Kim
- BK21PLUS Program in "Embodiment: Health-Society Interaction," Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Soo-Yeon Kim
- BK21PLUS Program in "Embodiment: Health-Society Interaction," Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea
| | - Jong-Tae Lee
- BK21PLUS Program in "Embodiment: Health-Society Interaction," Department of Public Health Science, Graduate School, Korea University, Seoul, South Korea; School of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea.
| |
Collapse
|
12
|
Byun G, Kim S, Kim SY, Park D, Shin MJ, Oh H, Lee JT. Blood Lead Concentrations and Mortality in Korean Adults: the Korea National Health and Nutrition Examination Survey with Mortality Follow-Up. Int J Environ Res Public Health 2020; 17:ijerph17186898. [PMID: 32967243 PMCID: PMC7557382 DOI: 10.3390/ijerph17186898] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022]
Abstract
Previous studies have consistently reported an increase in mortality risk, even at low levels of blood lead. The average blood lead concentration in the Korean population has steadily decreased but is still higher than that of developed countries. The purpose of this study was to examine the associations between mortality and blood lead concentrations for adults in Korea. We used the Korea National Health and Nutrition Examination Survey (2008–2013) linked Cause of Death data, which are followed by 2018. A total of 7308 subjects who aged over 30 at the baseline examination were included in the analyses. Cox proportional hazard model was used to estimate the hazard ratios of mortality from non-accidental causes and cancer mortality. The estimated hazard ratios (95% CI) for comparison of the second and third tertile group with the lowest tertile group were 2.01 (1.20, 3.40) and 1.91 (1.13, 3.23) for non-accidental mortality and 3.42 (95% CI: 1.65, 7.08) and 2.27 (95% CI: 1.09, 4.70) for cancer mortality, respectively. The dose–response relationship also showed significant increase in the risk of mortality at blood lead level between 1.5 and 6.0 μg/dL. Our findings suggest that potent policies to lower lead exposure are required for the general Korean population.
Collapse
Affiliation(s)
- Garam Byun
- Department of Public Health Science, Graduate School, Korea University, Seoul 02841, Korea; (G.B.); (S.-Y.K.)
| | - Sera Kim
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea; (S.K.); (D.P.); (M.-J.S.); (H.O.)
| | - Soo-Yeon Kim
- Department of Public Health Science, Graduate School, Korea University, Seoul 02841, Korea; (G.B.); (S.-Y.K.)
| | - Dahyun Park
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea; (S.K.); (D.P.); (M.-J.S.); (H.O.)
| | - Min-Jeong Shin
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea; (S.K.); (D.P.); (M.-J.S.); (H.O.)
- School of Biosystems and Biomedical Sciences, College of Health Science Korea University, Seoul 02841, Korea
| | - Hannah Oh
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea; (S.K.); (D.P.); (M.-J.S.); (H.O.)
- School of Health Policy and Management, College of Health Science, Korea University, Seoul 02841, Korea
| | - Jong-Tae Lee
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul 02841, Korea; (S.K.); (D.P.); (M.-J.S.); (H.O.)
- School of Health Policy and Management, College of Health Science, Korea University, Seoul 02841, Korea
- Correspondence:
| |
Collapse
|
13
|
Byun G, Kim H, Choi Y, Lee JT. The difference in effect of ambient particles on mortality between days with and without yellow dust events: Using a larger dataset in Seoul, Korea from 1998 to 2015. Sci Total Environ 2019; 691:819-826. [PMID: 31326805 DOI: 10.1016/j.scitotenv.2019.07.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Yellow Dust (YD) is a natural source of particulate matter (PM) in Korea. It remarkably increases the concentration of PM. However, characteristics of PM in YD period are different from those of PM in non-YD period. OBJECTIVES To investigate whether the association of PM with mortality is different between all days and non-YD days in Seoul, Korea, 1998-2015. METHODS We applied time-stratified case-crossover design to estimate effects of PM10 and PM2.5 on non-accidental cardiovascular and respiratory mortality. Effect estimates of PM were compared for all days in the study period and days without YD events. To identify whether different effect estimates between all days and non-YD days were not merely caused by the exclusion of high PM concentrations but rather by YD itself, we estimated effects of PM by randomly excluding the same number of days as days of YD. RESULTS A total of 4,509,392 deaths were observed during the study period. A 10 μg/m3 increase in PM10 or PM2.5 was associated with a 0.15% (95% CI: 0.06% to 0.24%) or 0.27% (95% CI: 0.07% to 0.47%) increase in risk of non-accidental mortality for all days, respectively. These associations were changed to 0.30% (95% CI: 0.18% to 0.42%) and 0.33% (95% CI: 0.10% to 0.55%) when YD days were excluded from analyses. We also found that effect estimates of PM were larger when YD days were excluded than those when high PM concentrations were randomly excluded. CONCLUSIONS The effect estimates of PM differed between all days and non-YD days. Our study suggests that including YD days in the analyses is likely to attenuate the effect of PM in a usual urban environment.
Collapse
Affiliation(s)
- Garam Byun
- The BK21PLUS Program in 'Embodiment: Health-Society Interaction', Department of Public Health Science, Graduate School, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Honghyok Kim
- The BK21PLUS Program in 'Embodiment: Health-Society Interaction', Department of Public Health Science, Graduate School, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yongsoo Choi
- The BK21PLUS Program in 'Embodiment: Health-Society Interaction', Department of Public Health Science, Graduate School, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Jong-Tae Lee
- The BK21PLUS Program in 'Embodiment: Health-Society Interaction', Department of Public Health Science, Graduate School, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea; School of Health Policy and Management, College of Health Science, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul, 0284e1, Republic of Korea.
| |
Collapse
|
14
|
Kim H, Kim H, Byun G, Choi Y, Song H, Lee JT. Difference in temporal variation of temperature-related mortality risk in seven major South Korean cities spanning 1998-2013. Sci Total Environ 2019; 656:986-996. [PMID: 30625685 DOI: 10.1016/j.scitotenv.2018.11.210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 06/09/2023]
Abstract
Temporal variation of temperature-related mortality risk is an important issue in climate change era. However, difference in this temporal variation across cities in South Korea remains unclear. The aim of this study was to explore whether temporal variation might differ spatially across seven metropolitan cities of Korea during the period of 1998-2013. We estimated cumulative associations between temperature (up to previous 14 days of exposure) and all-cause mortality, and compared cumulative associations between the first eight years (1998-2005) and the last eight years (2006-2013). Multivariate meta-regression analysis was performed to investigate what factors might be associated with spatial and temporal variation in cumulative associations. We found that Busan, Daegu, and Gwangju experienced decrease in heat effect from 1998-2005 to 2006-2013, while Incheon experienced increase in heat effect. By comparing mortality risk at 99th percentile of temperature to mortality risk at minimum mortality temperature, percentage increase of mortality risk changed from 4.8% (95% CI: -1.3, 11.3) to 0.4% (95% CI: -6.0, 7.4) in Busan, from 17.2% (95% CI: 10.2, 24.7) to 4.0% (95% CI: -1.4, 9.8) in Daegu, from 20.3% (95% CI: 11.5, 29.7) to 2.2% (95% CI: -3.5, 8.3) in Gwangju, and from 3.5% (95% CI: 0.2, 6.8) to 7.9% (95% CI: 5.0, 10.9) in Incheon, respectively. Change in average temperature from 1998-2005 to 2006-2013 was negatively associated with change in heat effect even though average temperature in most of the cities fluctuated over time. We also found that all seven cities had decrease in effect of moderate cold temperature from 1998-2005 to 2006-2013. Such decrease was associated with improvement in medical resources. Results of this study suggest that plans for adaptation to temperature-related risks should differ across populations because adaptation to temperature varies across populations and within the same population over different time.
Collapse
Affiliation(s)
- Honghyok Kim
- BK21PLUS Program in 'Embodiment: Health-Society Interaction', Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea
| | - Hyomi Kim
- BK21PLUS Program in 'Embodiment: Health-Society Interaction', Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea
| | - Garam Byun
- BK21PLUS Program in 'Embodiment: Health-Society Interaction', Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea
| | - Yongsoo Choi
- BK21PLUS Program in 'Embodiment: Health-Society Interaction', Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea
| | - Hyeonjin Song
- BK21PLUS Program in 'Embodiment: Health-Society Interaction', Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea
| | - Jong-Tae Lee
- BK21PLUS Program in 'Embodiment: Health-Society Interaction', Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea; Department of Environmental Health, Korea University, Seoul, Republic of Korea; School of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea.
| |
Collapse
|