BK21PLUS Program in 'Embodiment: Health -Society Interaction', Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea.
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.
Environ Int. 2019 Apr;125:595-605. doi: 10.1016/j.envint.2018.09.004. Epub 2019 Feb 11.
Lag is one of the major uncertainties in the heterogeneity of short-term effects of particulate matter with aerodynamic diameter <10 μm (PM) on mortality. This study aimed to explore spatial variations in extended lag effects of PM on all-cause mortality, cardiovascular mortality and respiratory mortality in seven major South Korean cities over a period spanning 2006-2013. We did time-series analysis using generalized linear models and adjusted for temporal trend, day of the week, holiday, influenza epidemic, and weather. Single lag models and distributed lag models were extensively compared, specifically in terms of lag interval, and adjustment for temporal trend. We also conducted a time-stratified case-crossover analysis. Multivariate meta-regressions with city characteristic variables were conducted in order to assess spatial variation in the lag structure. When considering up to previous 45 days of exposure, we found longer lag associations between PM and mortality, particularly in all-cause mortality and respiratory mortality. SO, the ratio of SO to PM and gross regional domestic product were all found to positively contribute towards the associations between PM and all-cause mortality and cardiovascular mortality. Ulsan (Korea's largest industrial city) was found to have the strongest cumulative percentage increases in all-cause mortality and cardiovascular mortality per 10 μg/m increase of PM: 4.9% (95% CI: 2.5, 7.3) and 4.3% (95% CI: -0.9, 9.7) respectively. Busan (Korea's largest seaport city) was found to have the highest cumulative percentage increase in respiratory mortality with an 8.2% increase (95% CI: 2.8, 13.8). In summary, the short-term effects of PM on mortality may persist over a period of not just few weeks but longer than a month, and may differ according to regional economy. This study provides public health implication that, in order to minimize the health effects of PM, air quality interventions should focus on not only particulate pollution but also gaseous pollution, such as SO.
滞后是颗粒物（PM）短期影响异质性的主要不确定性之一，其空气动力学直径<10 μm 会导致死亡率上升。本研究旨在探索韩国七个主要城市在 2006-2013 年期间 PM 对全因死亡率、心血管死亡率和呼吸死亡率的长期滞后效应的空间变化。我们使用广义线性模型进行时间序列分析，并调整了时间趋势、星期几、节假日、流感流行和天气。我们广泛比较了单滞后模型和分布式滞后模型，特别是在滞后间隔和时间趋势调整方面。我们还进行了时间分层病例交叉分析。为了评估滞后结构的空间变化，对城市特征变量进行了多元荟萃回归分析。考虑到之前 45 天的暴露，我们发现 PM 与死亡率之间的滞后关联时间更长，尤其是在全因死亡率和呼吸死亡率方面。因此，SO 和 PM 的比例以及总地区国内生产总值都被发现对 PM 与全因死亡率和心血管死亡率之间的关联有正向贡献。蔚山（韩国最大的工业城市）被发现对 PM 每增加 10μg/m3 引起的全因死亡率和心血管死亡率的累积百分比增加最大，分别为 4.9%（95%CI：2.5，7.3）和 4.3%（95%CI：-0.9，9.7）。釜山（韩国最大的海港城市）被发现呼吸死亡率的累积百分比增加最高，增加了 8.2%（95%CI：2.8，13.8）。总之，PM 对死亡率的短期影响可能持续时间不止数周，甚至超过一个月，并且可能因地区经济而异。本研究为公共卫生提供了启示，为了最大限度地减少 PM 的健康影响，空气质量干预措施不仅应针对颗粒物污染，还应针对 SO 等气态污染。
