Clinical Trial Center, Dongguk University Ilsan Hospital, Goyang, South Korea; Research Center for Chronic Disease and Environmental Medicine, Dongguk University College of Medicine, Gyeongju, South Korea.
Department of Health Administration and Management, Soonchunhyang University Graduate School, Asan, South Korea.
Sci Total Environ. 2024 Feb 20;912:169202. doi: 10.1016/j.scitotenv.2023.169202. Epub 2023 Dec 12.
Although injuries are a leading cause of death and affect the life expectancy of individuals who live with disabilities globally, the potential role of air pollution exposure on injuries due to external causes has received little scientific attention, especially compared with that given to the association of air pollution and non-external causes of morbidity and mortality. We investigated the association between emergency department visits for externally caused injuries and short-term exposure to major ambient air pollutants, with focus on the intentions and mechanisms of injuries. We identified 2,049,855 injured patients in Seoul, South Korea between 2008 and 2016 using the National Emergency Database. Daily short-term exposure to air pollution including particles <10 μm (PM) and <2.5 μm (PM), nitrogen dioxide (NO), sulfur dioxide (SO), carbon monoxide (CO), and ozone (O) was estimated based on hourly concentrations. We employed a time-stratified case-crossover study design using a conditional Poisson regression model adjusted for meteorological variables, influenza epidemics, and holidays. Immediate exposure (lag 0) to most pollutants significantly increased the risk of total injuries (PM, 0.42 %; NO, 0.68 %; SO, 1.05 %; CO, 0.57 %; O, 1.86 % per interquartile range increment), and the associations differed according to the intention and mechanism of injury. Unintentional and assault injuries were significantly associated with air pollution exposure, whereas self-harm injuries showed no association. In mechanism-specific analyses, injuries caused by falls, blunt objects, penetration, traffic accidents, machinery, and slips were associated with specific air pollutants, even in the co-pollutant models. The associations were stronger in injured patients aged <15 years, and in males than in their counterparts. Our results suggest that short-term air pollution exposure might play a role in the risk of externally caused injuries and the association may differ depending on the intention and mechanism of injury, which provide important evidence for injury prevention and air quality strategies.
尽管伤害是导致死亡的主要原因，并影响到全球残疾人群的预期寿命，但空气污染暴露对外因性伤害的潜在作用几乎没有引起科学界的关注，与空气污染与非外部原因的发病率和死亡率之间的关联相比，更是如此。我们调查了因外部原因导致的急诊就诊与短期暴露于主要环境空气污染物之间的关联，重点关注伤害的意图和机制。我们利用韩国国家急救数据库，确定了 2008 年至 2016 年间首尔因外伤就诊的 2049855 名患者。根据每小时浓度，估计了包括<10μm（PM）和<2.5μm（PM）、二氧化氮（NO）、二氧化硫（SO）、一氧化碳（CO）和臭氧（O）在内的短期每日空气污染暴露量。我们采用时间分层病例交叉研究设计，使用条件泊松回归模型进行调整，以适应气象变量、流感流行和节假日的影响。大多数污染物的即时暴露（滞后 0 期）显著增加了总伤害（PM，0.42%；NO，0.68%；SO，1.05%；CO，0.57%；O，1.86%每增加一个四分位距）的风险，且关联因伤害的意图和机制而异。意外伤害和攻击伤与空气污染暴露显著相关，而自伤则没有关联。在机制特异性分析中，跌倒、钝器、穿透、交通事故、机械和滑倒引起的伤害与特定空气污染物相关，即使在共污染物模型中也是如此。在<15 岁的受伤患者和男性中，关联更强。我们的研究结果表明，短期空气污染暴露可能会增加因外部原因导致的伤害风险，且关联可能因伤害的意图和机制而异，这为伤害预防和空气质量策略提供了重要证据。
