Epidemiology and Health

Hyun-Joo Bae

2 Articles

Mortality burden attributable to long-term exposure to fine particulate matter among older adults in Korea: Jongmin Oh, Jisun Myung, Changwoo Han, Hyun-Joo Bae, Soontae Kim, Yun-Chul Hong, Dong-Wook Lee, Youn-Hee Lim; Epidemiol Health. 2025;47:e2025028. Published online May 28, 2025; DOI: https://doi.org/10.4178/epih.e2025028

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to evaluate the association between long-term exposure to particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) 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 PM2.5 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 PM2.5 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 PM2.5 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 PM2.5 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 PM2.5 levels in Korea have shown a declining trend over the past decade, mortality among older adults associated with long-term PM2.5 exposure has not significantly decreased, likely due to the rapid aging of the population.; 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.

Effect modification of consecutive high concentration days on the association between fine particulate matter and mortality: a multi-city study in Korea: Hyungryul Lim, Sanghyuk Bae, Jonghyuk Choi, Kyung-Hwa Choi, Hyun-Joo Bae, Soontae Kim, Mina Ha, Ho-Jang Kwon; Epidemiol Health. 2022;44:e2022052. Published online June 9, 2022; DOI: https://doi.org/10.4178/epih.e2022052

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Although there is substantial evidence for the short-term effect of fine particulate matter (PM2.5) on daily mortality, few epidemiological studies have explored the effect of prolonged continuous exposure to high concentrations of PM2.5. This study investigated how the magnitude of the mortality effect of PM2.5 exposure is modified by persistent exposure to high PM2.5 concentrations.

METHODS

We analyzed data on the daily mortality count, simulated daily PM2.5 level, mean daily temperature, and relative humidity level from 7 metropolitan cities from 2006 to 2019. Generalized additive models (GAMs) with quasi-Poisson distribution and random-effects meta-analyses were used to pool city-specific effects. To investigate the effect modification of continuous exposure to prolonged high concentrations, we applied categorical consecutive-day variables to the GAMs as effect modification terms for PM2.5.

RESULTS

The mortality risk increased by 0.33% (95% confidence interval [CI], 0.16 to 0.50), 0.47% (95% CI, -0.09 to 1.04), and 0.26% (95% CI, -0.08 to 0.60) for all-cause, respiratory, and cardiovascular diseases, respectively, with a 10 μg/m3 increase in PM2.5 concentration. The risk of all-cause mortality per 10 μg/m3 increase in PM2.5 on the first and fourth consecutive days significantly increased by 0.63% (95% CI, 0.20 to 1.06) and 0.36% (95% CI, 0.01 to 0.70), respectively.

CONCLUSIONS

We found increased risks of all-cause, respiratory, and cardiovascular mortality related to daily PM2.5 exposure on the day when exposure to high PM2.5 concentrations began and when exposure persisted for more than 4 days with concentrations of ≥35 μg/m3. Persistently high PM2.5 exposure had a stronger effect on seniors.

Summary

Korean summary
한국의 7개 대도시를 배경으로 수행한 본 시계열 연구를 통하여 2006년부터 2019년까지의 기간 동안에 초미세먼지의 단기 노출이 일별 사망률을 증가시키며, 교호작용모형을 통해 일평균 35 μg/m3 이상의 고농도 지속기간이 처음 시작되는 날과 넷째 지속일에 이러한 사망효과가 커짐을 보고하였다. 이러한 고농도 지속기간의 교호작용은 65세 이상 연령군에서 더욱 두드러졌다.

Key Message
With our Korean multi-city study design from 2006 to 2019, the short-term effects of PM2.5 on mortality were greater when the high PM2.5 concentration duration began during the day and lasted for approximately 4 days, and the elderly may be more affected by persistently high PM2.5.

Citations

Citations to this article as recorded by

Estimating Health and Economic Benefits from PM2.5 Reduction in Fishery-Based Communities: A Sector-Specific Approach to Sustainable Air Quality Management in the Philippines
James Roy Lesidan, Nadine Grace Caido, Oliver Semblante, Floro Junior Roque, Jejomar Bulan, Jumar Cadondon, Maria Cecilia Galvez, Edgar Vallar
Sustainability.2025; 17(3): 1316. CrossRef

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