Kim Sun-Young, O'Neill Marie S, Lee Jong-Tae, Cho Youngtae, Kim Jaiyong, Kim Ho
Department of Environment and Occupational Health Sciences, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA.
Int Arch Occup Environ Health. 2007 Aug;80(8):701-10. doi: 10.1007/s00420-007-0182-3. Epub 2007 Mar 15.
Some epidemiological literature has observed that air pollution effects on health differed across regional or individual socioeconomic position. This study evaluated whether regional and individual socioeconomic position, as indicated by health insurance premiums, modified the effect of air pollution on hospital visits for asthma.
Effects of ambient air pollutants (particulate matter, carbon monoxide, sulfur dioxide, nitrogen dioxide, and ozone) on 92,535 emergency out-patient hospital visits for asthma in Seoul, Korea during 2002 were estimated using case-crossover analysis, adjusting for time trend, weather conditions, and seasonality. Next, interactions between air pollutants and Korean National Health Insurance premium (1) for the individual patient and (2) averaged across the patient's residence district, were entered, first singly then jointly, in the models.
Relative risks of emergency outpatient hospital visits were all positively and significantly associated with interquartile increases for selected lags for all air pollutants. In the regression model with interaction terms for both individual premium and regional-average premium, associations with all five-air pollutants ranged from 1.03 to 1.09 times higher among the lowest premium districts compared to the highest premium districts. Of all the pollutants, nitrogen dioxide showed the strongest associations in lower premium districts compared to the higher premium districts. Individual socioeconomic position did not modify the associations in either the single or joint interaction models.
In Seoul, community but not individual socioeconomic conditions modified risk of asthma hospital visits on high air pollution days.
一些流行病学文献观察到，空气污染对健康的影响因地区或个体社会经济地位而异。本研究评估了以医疗保险费用表示的地区和个体社会经济地位是否会改变空气污染对哮喘住院就诊的影响。
采用病例交叉分析方法，对2002年韩国首尔92535例哮喘急诊门诊就诊病例进行研究，估算环境空气污染物（颗粒物、一氧化碳、二氧化硫、二氧化氮和臭氧）的影响，并对时间趋势、天气状况和季节性进行调整。接下来，将空气污染物与韩国国民健康保险费用之间的相互作用（1）针对个体患者，（2）针对患者居住地区的平均值，先单独然后联合纳入模型。
所有空气污染物选定滞后四分位数间距增加与急诊门诊就诊的相对风险均呈正相关且具有统计学意义。在包含个体保险费用和地区平均保险费用交互项的回归模型中，与所有五种空气污染物的关联在最低保险费用地区比最高保险费用地区高1.03至1.09倍。在所有污染物中，与较高保险费用地区相比，二氧化氮在较低保险费用地区的关联最强。个体社会经济地位在单一或联合交互模型中均未改变这种关联。
在首尔，社区而非个体社会经济状况会改变高空气污染日哮喘住院就诊的风险。
