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Mortality burden attributable to long-term exposure to fine particulate matter among older adults in Korea
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Jongmin Oh, Jisun Myung, Changwoo Han, Hyun-Joo Bae, Soontae Kim, Yun-Chul Hong, Dong-Wook Lee, Youn-Hee Lim
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Epidemiol Health. 2025;47:e2025028. Published online May 28, 2025
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DOI: https://doi.org/10.4178/epih.e2025028
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 Abstract
Summary
 PDF Supplementary Material
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Abstract
OBJECTIVES
This study aimed to evaluate the association between long-term exposure to particulate matter with an aerodynamic diameter <2.5 μm (PM<sub>2.5</sub>) and cause-specific mortality among older adults in Korea, providing insights into the evolving public health burden in an aging society.
METHODS We analyzed national insurance claims data spanning 2010-2019. Modeled PM<sub>2.5</sub> concentrations were assigned to participants according to their residential districts. We employed time-varying Cox proportional hazard models, using age as the time scale, adjusted for potential confounders. Six cause-specific mortalities were considered: ischemic heart disease (IHD), stroke, chronic obstructive pulmonary disease (COPD), acute lower respiratory infection (ALRI), lung cancer (LC), and type 2 diabetes mellitus (T2DM). Annual excess deaths attributable to long-term PM<sub>2.5</sub> exposure were calculated.
RESULTS A total of 5,360,032 older adults were followed from 2010 to 2019. Hazard ratios (HRs) per 10 μg/m3 increase in 12-month PM<sub>2.5</sub> concentration were as follows: IHD, 1.068 (95% CI, 1.040 to 1.097); stroke, 1.023 (95% CI, 1.003 to 1.043); ALRI, 1.050 (95% CI, 1.026 to 1.076); COPD, 1.114 (95% CI, 1.072 to 1.157); T2DM, 1.046 (95% CI, 1.007 to 1.086); and LC, 0.972 (95% CI, 0.948 to 0.996). Excess deaths attributable to long-term PM<sub>2.5</sub> exposure were estimated at 4,888 (95% CI, 2,304 to 7,323) in 2010 and 5,179 (95% CI, 2,585 to 7,648) in 2019.
CONCLUSIONS Although PM<sub>2.5</sub> levels in Korea have shown a declining trend over the past decade, mortality among older adults associated with long-term PM<sub>2.5</sub> exposure has not significantly decreased, likely due to the rapid aging of the population.
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Summary
Korean summary
2010–2019년 동안 대한민국 노인 536만 명 대상의 후향적 코호트 연구를 수행하였다.
장기적인 초미세먼지(PM2.5) 노출은 허혈성 심질환, 뇌졸중, 하기도 감염, 만성폐쇄성폐질환, 제2형 당뇨병으로 인한 사망 위험 증가와 관련성이 있었다. 연간 PM2.5 농도는 감소했으나, 고령화로 인해 PM2.5에 기인한 초과 사망은 2010년 4,888명에서 2019년 5,179명으로 증가하였다. 대기질 개선에도 불구하고 고령화로 인해 PM2.5로 인한 사망 부담은 여전히 중요한 공중보건 문제이다.
Key Message
A retrospective cohort of 5.36 million older adults was followed from 2010 to 2019 in Korea. Long-term PM2.5 exposure was associated with increased mortality from IHD, stroke, ALRI, COPD, and T2DM. Although annual PM2.5 concentrations declined, excess deaths rose from 4,888 in 2010 to 5,179 in 2019, largely driven by population aging. Despite improvements in air quality, the PM2.5-related mortality burden remains a significant public health concern due to population aging.
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Age-specific effects of ozone on pneumonia in Korean children and adolescents: a nationwide time-series study
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Kyoung-Nam Kim, Youn-Hee Lim, Sanghyuk Bae, In Gyu Song, Soontae Kim, Yun-Chul Hong
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Epidemiol Health. 2022;44:e2022002. Published online December 28, 2021
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DOI: https://doi.org/10.4178/epih.e2022002
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Abstract
Summary
PDFSupplementary Material
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Abstract
OBJECTIVES
The aim of this study was to estimate the age-specific effects of 8-hour maximum ozone levels on pneumonia in children and adolescents.
METHODS We performed quasi-Poisson regression analyses for individuals of 0-4 years, 5-9 years, 10-14 years, and 15-19 years of age using nationwide time-series data from the Korea (2011-2015). We constructed distributed lag linear models employing a generalized difference-in-differences method and controlling for other air pollutants.
RESULTS A 10.0-parts per billion increase in 8-hour maximum ozone levels was associated with a higher risk of hospital admissions due to pneumonia at 0-4 (relative risk [RR], 1.02; 95% confidence interval [CI], 1.01 to 1.03) and 5-9 years of age (RR, 1.06; 95% CI, 1.04 to 1.08), but not at 10-14 (RR, 1.01; 95% CI, 0.98 to 1.04) or 15-19 years of age (RR, 1.01; 95% CI, 0.97 to 1.06). The association between ozone and hospital admissions due to pneumonia was stronger in cool seasons (from November to April) than in warm seasons (from May to October), but was similar between boys and girls.
CONCLUSIONS Short-term exposure to ozone was associated with a higher risk of pneumonia at 0-4 years and 5-9 years of age, but not at 10-14 years or 15-19 years of age. Our findings can help identify vulnerable periods, determine the target populations for public health interventions, and establish air pollution standards.
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Summary
Korean summary
-어린이와 청소년에서 대기오염물질인 오존에 단기 노출되었을 때 폐렴으로 인한 입원 위험이 증가하는지를 건강보험공단 청구자료를 이용하여 구축한 시계열자료로 분석하였다.
-0-4세, 5-9세 군에서는 오존 단기 노출 시 폐렴으로 인한 입원 위험이 증가하였으나 10-14세, 15-19세 군에서는 입원 위험 증가가 관찰되지 않았다.
Key Message
• The effects of ozone levels on hospital admissions for pneumonia were evaluated.
• We used quasi-Poisson time-series models and a difference-in-differences method.
• Ozone levels increased hospital admissions for pneumonia at ages 0–4 and 5–9 years.
• Evidence for the effects of ozone levels on pneumonia was not found at older ages.
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Citations
Citations to this article as recorded by  - Short-term effects of ambient ozone on pediatric pneumonia hospital admissions: a multi-city case-crossover study in China
Huan Wang, Huan-Ling Zeng, Guo-Xing Li, Shuang Zhou, Jin-Lang Lyu, Qin Li, Guo-Shuang Feng, Hai-Jun Wang
Environmental Health and Preventive Medicine.2025; 30: 75. CrossRef - Challenges of Air Pollution and Health in East Asia
Xihao Du, Renjie Chen, Haidong Kan
Current Environmental Health Reports.2024; 11(2): 89. CrossRef - Intraday exposure to ambient ozone and emergency department visits among children: a case-crossover study in southern China
Jiahong Ren, Lifeng Zhu, Yachen Li, Haiyi Li, Qian Hu, Jian Zhu, Qingyan Zhang, Yunquan Zhang
Environmental Science and Pollution Research.2023; 30(30): 74853. CrossRef
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