From the School of the Environment, Yale University, New Haven, CT.
Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
Epidemiology. 2022 Jan 1;33(1):17-24. doi: 10.1097/EDE.0000000000001430.
Several studies have shown that long-term exposure to air pollution is associated with reduced kidney function. However, less is known about effects of short-term exposure to air pollution on kidney disease aggravation and resultant emergency room (ER) burden. This study aimed to estimate excess ER visits attributable to short-term air pollution and to provide evidence relevant to air pollution standards to protect kidney patients.
We conducted time-series analysis using National Health Insurance data covering all persons in South Korea (2003-2013). We collected daily data for air pollutants (particulate matter ≤10 µm [PM10], ozone [O3], carbon monoxide [CO], and sulfur dioxide [SO2]) and ER visits for total kidney and urinary system disease, acute kidney injury (AKI), and chronic kidney disease (CKD). We performed a two-stage time-series analysis to estimate excess ER visits attributable to air pollution by first calculating estimates for each of 16 regions, and then generating an overall estimate.
For all kidney and urinary disease (902,043 cases), excess ER visits attributable to air pollution existed for all pollutants studied. For AKI (76,330 cases), we estimated the highest impact on excess ER visits from O3, while for CKD (210,929 cases), the impacts of CO and SO2 were the highest. The associations between air pollution and kidney ER visits existed for days with air pollution concentrations below current World Health Organization guidelines.
This study provides quantitative estimates of ER burdens attributable to air pollution. Results are consistent with the hypothesis that stricter air quality standards benefit kidney patients.
多项研究表明，长期暴露于空气污染与肾功能下降有关。然而，对于短期暴露于空气污染对肾脏病恶化及由此导致的急诊室（ER）负担的影响知之甚少。本研究旨在评估短期空气污染导致的急诊室就诊人数的超额负担，并提供与保护肾脏病患者的空气污染标准相关的证据。
我们使用涵盖韩国所有人（2003-2013 年）的国家健康保险数据进行时间序列分析。我们收集了每日的空气污染物（≤10 µm 的颗粒物 [PM10]、臭氧 [O3]、一氧化碳 [CO] 和二氧化硫 [SO2]）和 ER 就诊数据，用于所有肾脏和泌尿系统疾病、急性肾损伤（AKI）和慢性肾脏病（CKD）。我们进行了两阶段时间序列分析，以估计空气污染导致的急诊室就诊人数的超额负担，首先计算了 16 个地区的每个地区的估计值，然后生成了总体估计值。
对于所有肾脏和泌尿系统疾病（902,043 例），所有研究的污染物都存在归因于空气污染的急诊室就诊人数的超额负担。对于 AKI（76,330 例），我们估计 O3 对急诊室就诊人数的影响最大，而对于 CKD（210,929 例），CO 和 SO2 的影响最大。在空气污染浓度低于当前世界卫生组织指南的日子里，空气污染与肾脏 ER 就诊之间存在关联。
本研究提供了归因于空气污染的急诊室负担的定量估计。结果与更严格的空气质量标准有利于肾脏病患者的假设一致。
