Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea; School of the Environment, Yale University, CT, USA.
School of the Environment, Yale University, CT, USA.
Environ Res. 2021 May;196:110989. doi: 10.1016/j.envres.2021.110989. Epub 2021 Mar 6.
Concentration-response function for exposure to ambient particulate matter (PM) and mortality (i.e., relative risk, RR) may be inequal across communities by socioeconomic conditions. Investigation on specific mechanisms of this inequality regarding susceptibility to PM, beyond non-specific "socioeconomic conditions", would provide policy-relevant implications for tackling this inequality. However, such investigation via epidemiological studies is challenged by residual confounding by correlated mechanisms and different loss of life expectancy by PM exposures between communities. Here, we aimed to assess community characteristics including different aspects of socioeconomic deprivation, medical resources, health behaviors, air quality, and greenness in their relation to inequal RR for PM and cause-specific mortality in 72 municipalities in South Korea, 2006-2013, considering these challenges. We found that a 10 μg/m increase in PM on average across 46 days was associated with a 1.05% (95% CI: 0.24, 1.88) increase in all-cause mortality (ALL), 1.32% (95% CI: -0.29, 2.95) increase in cardiovascular mortality (CVD), and 6.47% (95% CI: 3.06, 10.00) increase in respiratory mortality (RES). The association between PM and mortality was higher in communities with higher ratio of SO to PM (ALL and RES), higher material deprivation (ALL, CVD, and RES), lower medical resources (CVD), higher prevalence of drinking (ALL and CVD), and lower prevalence of smoking (CVD and RES). Lag-structures showed smaller loss of life expectancy by PM exposures in communities with higher prevalence of smoking. Our findings suggest that PM-related health inequalities are shaped by a variety of mechanisms relating to susceptibility to PM exposures and different loss of life expectancy. Health policies controlling community characteristics may contribute to minimizing PM-related health inequalities in those perspectives.
暴露于环境颗粒物（PM）和死亡率（即相对风险，RR）的浓度-反应函数可能因社会经济条件在不同社区之间不平等。除了非特异性的“社会经济条件”之外，对于易感性和 PM 暴露之间死亡率差异的具体机制的研究，将为解决这种不平等提供具有政策意义的影响。然而，这种通过流行病学研究进行的调查受到相关机制的残余混杂和不同社区之间因 PM 暴露导致的预期寿命损失的挑战。在这里，我们旨在评估社区特征，包括社会经济剥夺的不同方面、医疗资源、健康行为、空气质量和绿化程度，以及它们与韩国 72 个城市 2006-2013 年期间 PM 与特定原因死亡率的 RR 不平等之间的关系，同时考虑到这些挑战。我们发现，在 46 天内平均 PM 增加 10μg/m 与全因死亡率（ALL）增加 1.05%（95% CI：0.24，1.88）、心血管死亡率（CVD）增加 1.32%（95% CI：-0.29，2.95）和呼吸死亡率（RES）增加 6.47%（95% CI：3.06，10.00）相关。PM 与死亡率之间的相关性在 SO 与 PM 比值较高的社区（ALL 和 RES）、物质剥夺程度较高的社区（ALL、CVD 和 RES）、医疗资源较低的社区（CVD）、饮酒比例较高的社区（ALL 和 CVD）和吸烟比例较低的社区（CVD 和 RES）中更高。滞后结构显示，吸烟比例较高的社区因 PM 暴露导致的预期寿命损失较小。我们的研究结果表明，PM 相关的健康不平等受到与 PM 暴露易感性和不同预期寿命损失相关的各种机制的影响。控制社区特征的卫生政策可能有助于从这些角度减少 PM 相关的健康不平等。
