Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Associations between Air Pollution and Asthma-related Hospital Admissions in Children in Seoul, Korea: A Case-crossover Study

환자교차 설계 방법을 적용한 소아천식 입원에 대한 도시 대기오염의 급성영향평가

  • Lee, Jong-Tae (Department of Preventive Medicine, College of Medicine, Ewha Womans University)
  • 이종태 (이화여자대학교 의과대학 예방의학교실)
  • Published : 2003.03.01
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Abstract

Objectives : I used a case-crossover design to investigate the association between air pollution, and hospital admissions for asthmatic children under the age of 15 years in Seoul, Korea Methods : I estimated the changes in the levels of hospitalization risk from theinterquartile (IQR) increase in each pollutant concentrations, using conditional logistic regression analyses, with controls for weather information. Results : Using bidirectional control sampling, the results from a conditional logistic regression model, with controls for weather conditions, showed the estimated relative risk of hospitalization for asthma among children to be 1.04 (95% confidence interval (CI), 1.01-1.08) for particulate matter with an aerodynamic diameter less than or equal to 10m (IQR=40.4ug/m3); 1.05 (95% CI, 1.00- 1.09) for nitrogen dioxide (IQR=14.6ppb): 1.02 (95% CI,0.97-1.06) for sulfur dioxide (IQR=4.4ppb): 1.03 (95% CI, 0.99-1.08) for ozone (IQR=21.7ppb): and 1.03 (95% CI, 0.99-1.08) for carbon monoxide f10R=1.0ppm). Conclusions : This empirical analysis indicates the bidirectional control sampling methods, by design, would successfully control the confounding factors due to the long-term time trends of air pollution. These findings also support the hypothesis that air pollution at levels below the current ambient air quality standards of Korea is harmful to sensitive subjects, such as asthmatic children.

Keywords

References

  1. Dockery OW, Speizer FE, Stram DO, Ware JH, SpenglerJD, Ferns BG. Effects of inhalable particles on respiratory health of children. Am Rev Respir Dis 1989; 139: 587-594 https://doi.org/10.1164/ajrccm/139.3.587
  2. Schwartz J, Slater D, Larson TV, Peirson WE, Koenig JQ. Particulate air pollution and hospital emergency room visits for asthmain Seattle.Am Rev Respir Dis 1993; 147: 826-831 https://doi.org/10.1164/ajrccm/147.4.826
  3. Burnett RT, Cakmak S, Brook JR, Krewski D. The role of particulate size and chemistry in the association between summertime ambient air pollution and hospitalization for cardiorespiratory disease. Environ Health Perspect 1997; 105: 614-620 https://doi.org/10.2307/3433607
  4. Delfino RJ, Murphy-Moulton AM, Burnett RT, Brook JR, Becklake MR. Effectsof air pollution on emergency room visits for respiratory illnesses in Montreal, Quebec. Am J Respir crit Care Med 1997; 155: 568-576 https://doi.org/10.1164/ajrccm.155.2.9032196
  5. Lee JT, Kim H, Song H, Hong YC, Cho YS, Shin SY, Hyun YJ, Kim Ys.Air pollution and asthma among children in Seoul, Korea. Epidemiology 2002; 13: 481-484 https://doi.org/10.1097/00001648-200207000-00018
  6. Hanley QS, Koenig JQ, Larson TV, Anderson TL, van Belle G, Rebolledo V, Covert OS, Pierson WE. Response of young asthmatics to inhaled sulfuric acid. Am Rev Respir Dis 1992; 145: 326-331 https://doi.org/10.1164/ajrccm/145.2_Pt_1.326
  7. Koenig JQ. Effect of ozone on respiratory response in subjects with asthma. Environ Health Perspect 1995; 103 (suppI 2): 103-105 https://doi.org/10.1289/ehp.95103s9103
  8. Linn WS, Avol EL, Peng RC, Shamoo DA, Hackney 10. Replicated dose-response study of sulfur dioxide effects in normals, atopic, and asthmatic volunteers. Am Rev Respir Dis 1987; 136: 1127-1134 https://doi.org/10.1164/ajrccm/136.5.1127
  9. Balmes JR, Aris RM, Chen LL, Scannell C, Tager IE, Finkbeiner W, Christian D, Kelly T, Hearne PQ, Ferrando R, Welch B. Effects of Ozone on Normal and Potentially Sensitive Human Subject. Part I: Air way Inflammation and Responsiveness to Ozone in Normal and Asthmatic Subjects. Research Report No. 78. Cambridge, MA: Health Effect Institute, 1997
  10. Scannell C, Chen LL, Aris RM, Tager I, Christian D, Ferrando R, Welch B, Kelly T, Balmes JR. Greater ozone-induced inflammatory responses in subjects with asthma. Am J Respir Crit Care Med 1996; 154: 24-29 https://doi.org/10.1164/ajrccm.154.1.8680687
  11. Leem JH, Lee JT, Kim DG, Shin DC, Roh JH. Short-term effects of air pollution on hospital visits for respiratory diseases in Seoul. Korean J Occup Med 1998; 10(3): 333-342 (Korean)
  12. Lee YJ, Lee JT, Ju YS, Shin DC, Im HJ, Cho SH. Short-term effect of air pollution on respiratory disease in Seoul: A casecrossover study. Korean J Prev Med 2001; 4(3): 253-261 (Korean)
  13. Bates DV. Health indices of the adverse effects of air pollution: The question of coherence. Envrion Res 1992; 59: 336-349 https://doi.org/10.1016/S0013-9351(05)80040-4
  14. Maclure M. The case-crossover desing: a method for studying transient effects on the risk of acute events. Am J Epidemiol 1992; 133: 144-153
  15. Lee JT, Schwartz J. Reanalysis of the effects of air pollution on daily mortality in Seoul, Korea: A case-crossover design. Environ Health Perspect 1999; 107(8): 633-636 https://doi.org/10.2307/3434454
  16. Neas LM, Schwartz J, Dockery D. A casecrossover analysis of air pollution and mortality in Philadelphia. Environ Health Perspect 1999; 107:629-631 https://doi.org/10.2307/3434453
  17. Pope CA III. Mortality and air pollution: Associatio ns persist with continued advances in research methodology. Environ Health Perspect 1999; 107: 613-614 https://doi.org/10.1289/ehp.99107s4613
  18. Navidi W. Bidirectional case-crossover designs for exposures with time trends. Biometrics 1998; 54: 596-605 https://doi.org/10.2307/3109766
  19. Lee JT, Kim H, Schwartz J. Bidirectional case-crossover studies of air pollution: Bias from skewed and incomplete waves. Environ Health Perspect 2000; 108(12): 1107-1111 https://doi.org/10.2307/3434821
  20. Pope CA III, Schwartz J. Time series for the analysis of pulmonary health data. Am J Respir Crit Care Med 1996; 154: 5229-5233
  21. Akaike H. Statistical predictor identification. Ann Inst Stat Math 1970; 22: 203-217 https://doi.org/10.1007/BF02506337
  22. Bateson TF, Schwartz J. Control for seasonal variation and time trend in casecrossover studies of acute effects of environmental exposures. Epidemiology 1999; 10:539-544 https://doi.org/10.1097/00001648-199909000-00013
  23. Lee JT, Kim H. Epidemiologic methods and study designs for investigating adverse health effects of ambient air pollution. Korean J Prev Med 2001; 34: 119-126 (korean)
  24. Doelman CJA, Bast A. Oxygen radicals in lung pathology. Free Rad Biol Med 1990; 9: 381-400 https://doi.org/10.1016/0891-5849(90)90015-B
  25. Molfino NA, Wright SC, Katz I, Tarlo S, Silverman F, McClean PA, Szalai JP, Raizenne M, Slutsky AS, Zamel N. Effect of low concentrations of ozone on inhaled allergen responses in asthmatic subjects. Lancet 1991; 338: 199-203 https://doi.org/10.1016/0140-6736(91)90346-Q
  26. Strand V, Rak S, Svartengren M, Bylin G. Nitrogen dioxide exposure enhances asthmatic reaction to inhaled allergen in subjects with asthma. Am J Resp Crit Care Med 1997; 155: 881-887 https://doi.org/10.1164/ajrccm.155.2.9032196