Long-term exposure to PM2.5 and mortality: a national health insurance cohort study.

IF 6.4 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH International journal of epidemiology Pub Date : 2024-10-13 DOI:10.1093/ije/dyae140
Jeongmin Moon,Ejin Kim,Hyemin Jang,Insung Song,Dohoon Kwon,Cinoo Kang,Jieun Oh,Jinah Park,Ayoung Kim,Moonjung Choi,Yaerin Cha,Ho Kim,Whanhee Lee
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Abstract

BACKGROUND Previous studies with large data have been widely reported that exposure to fine particulate matter (PM2.5) is associated with all-cause mortality; however, most of these studies adopted ecological time-series designs or have included limited study areas or individuals residing in well-monitored urban areas. However, nationwide cohort studies including cause-specific mortalities with different age groups were sparse. Therefore, this study examined the association between PM2.5 and cause-specific mortality in South Korea using the nationwide cohort. METHODS A longitudinal cohort with 187 917 National Health Insurance Service-National Sample Cohort participants aged 50-79 years in enrolment between 2002 and 2019 was used. Annual average PM2.5 was collected from a machine learning-based ensemble model (a test R2 = 0.87) as an exposure. We performed a time-varying Cox regression model to examine the association between long-term PM2.5 exposure and mortality. To reduce the potential estimation bias, we adopted generalized propensity score weighting method. RESULTS The association with long-term PM2.5 (2-year moving average) was prominent in mortalities related to diabetes mellitus [hazard ratio (HR): 1.03 (95% CI: 1.01, 1.06)], circulatory diseases [HR: 1.02 (95% CI: 1.00, 1.03)] and cancer [HR: 1.01 (95% CI: 1.00, 1.02)]. Meanwhile, circulatory-related mortalities were associated with a longer PM2.5 exposure period (1 or 2-year lags), whereas respiratory-related mortalities were associated with current-year PM2.5 exposure. In addition, the association with PM2.5 was more evident in people aged 50-64 years than in people aged 65-79 years, especially in heart failure-related deaths. CONCLUSIONS This study identified the hypothesis that long-term exposure to PM2.5 is associated with mortality, and the association might be different by causes of death. Our result highlights a novel vulnerable population: the middle-aged population with risk factors related to heart failure.
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长期暴露于 PM2.5 与死亡率:一项全国医疗保险队列研究。
背景以前有大量数据研究广泛报道,暴露于细颗粒物(PM2.5)与全因死亡率相关;然而,这些研究大多采用生态时间序列设计,或包括有限的研究区域或居住在监测良好的城市地区的个人。然而,包括不同年龄段的特定死因的全国性队列研究却很少。因此,本研究利用全国性队列对韩国 PM2.5 与特定病因死亡率之间的关系进行了研究。方法本研究使用了 187 917 名年龄在 50-79 岁之间、在 2002 年至 2019 年期间注册的国民健康保险服务-全国抽样队列参与者组成的纵向队列。从基于机器学习的集合模型(测试 R2 = 0.87)中收集了 PM2.5 的年均值作为暴露量。我们采用时变 Cox 回归模型来研究 PM2.5 长期暴露与死亡率之间的关系。结果长期 PM2.5(2 年移动平均值)与糖尿病[危险比 (HR):1.03 (95% CI: 1.01, 1.06)]、循环系统疾病[HR:1.02 (95% CI: 1.00, 1.03)]和癌症[HR:1.01 (95% CI: 1.00, 1.02)]相关死亡率的关系十分突出。同时,循环系统相关的死亡率与较长的PM2.5暴露期(滞后1年或2年)有关,而呼吸系统相关的死亡率与当年的PM2.5暴露有关。此外,与 65-79 岁的人群相比,50-64 岁的人群与 PM2.5 的关联更为明显,尤其是与心力衰竭相关的死亡。我们的研究结果凸显了一个新的易感人群:具有心力衰竭相关风险因素的中年人群。
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来源期刊
International journal of epidemiology
International journal of epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
13.60
自引率
2.60%
发文量
226
审稿时长
3 months
期刊介绍: The International Journal of Epidemiology is a vital resource for individuals seeking to stay updated on the latest advancements and emerging trends in the field of epidemiology worldwide. The journal fosters communication among researchers, educators, and practitioners involved in the study, teaching, and application of epidemiology pertaining to both communicable and non-communicable diseases. It also includes research on health services and medical care. Furthermore, the journal presents new methodologies in epidemiology and statistics, catering to professionals working in social and preventive medicine. Published six times a year, the International Journal of Epidemiology provides a comprehensive platform for the analysis of data. Overall, this journal is an indispensable tool for staying informed and connected within the dynamic realm of epidemiology.
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