Epidemiology and Health

Original Article

Evaluation of an air quality warning system for vulnerable and susceptible individuals in Korea: an interrupted time series analysis: YouHyun Park, Jun Hyuk Koo, Hoyeon Jeong, Ji Ye Jung, Changsoo Kim, Dae Ryong Kang; Epidemiol Health. 2023;45:e2023020. Published online February 14, 2023; DOI: https://doi.org/10.4178/epih.e2023020

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study was conducted to elucidate the effects of an air quality warning system (AQWS) implemented in January 2015 in Korea by analyzing changes in the incidence and exacerbation rates of environmental diseases.
METHODS
Data from patients with environmental diseases were extracted from the National Health Insurance Service-National Sample Cohort database from 2010 to 2019, and data on environmental risk factors were acquired from the AirKorea database. Patient and meteorological data were linked based on residential area. An interrupted time series analysis with Poisson segmented regression was used to compare the rates before and after AQWS introduction. Adjustment variables included seasonality, air pollutants (carbon monoxide, nitrogen dioxide, sulfur dioxide, particulate matter less than 10 μm in diameter, and ozone), temperature, and humidity.
RESULTS
After AQWS implementation, the incidence of asthma gradually decreased by 20.5%. Cardiovascular disease and stroke incidence also significantly decreased (by 34.3 and 43.0%, respectively). However, no immediate or gradual decrease was identified in the exacerbation rate of any environmental disease after AQWS implementation. Sensitivity analyses were performed according to age, disability, and health insurance coverage type. Overall, the AQWS effectively mitigated the occurrence of most environmental diseases in Korea. However, the relationships between alarm system implementation and reduced incidence differed among diseases based on the characteristics of vulnerable and sensitive individuals.
CONCLUSIONS
Our results suggest that by tailoring the AQWS to demographic and sociological characteristics and providing enhanced education about the warning system, interventions can become an efficient policy tool to decrease air pollution-related health risks.; Summary

Korean summary
한국에서 미세먼지경보제의 시행은 환경성질환의 발생률을 점진적으로 감소시켰으나, 민감·취약계층 특징에 따라 정책 시행에 영향을 받은 환경성질환 종류는 상이하였다. 한편, 기존 환경성질환 환자의 악화(입원 또는 응급실 방문)의 경우 미세먼지경보제 시행으로 인한 영향은 파악되지 않았다.

Key Message
Air Quality Warning System (AQWS) effectively mitigated the occurrence of most environmental diseases in Korea. The relationships between alarm system implementation and reduced incidence differed among diseases based on the characteristics of vulnerable and sensitive individuals.

Cohort Profile

Cohort profile: the Environmental-Pollution-Induced Neurological EFfects (EPINEF) study: a multicenter cohort study of Korean adults: Heeseon Jang, Woojin Kim, Jaelim Cho, Jungwoo Sohn, Juhwan Noh, Gayoung Seo, Seung-Koo Lee, Young Noh, Sung Soo Oh, Sang-Baek Koh, Hee Jin Kim, Sang Won Seo, Ho Hyun Kim, Jung Il Lee, Sun-Young Kim, Changsoo Kim; Epidemiol Health. 2021;43:e2021067. Published online September 16, 2021; DOI: https://doi.org/10.4178/epih.e2021067

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4 Web of Science
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Abstract Summary PDF Supplementary Material

Abstract

The general population is exposed to numerous environmental pollutants, and it remains unclear which pollutants affect the brain, accelerating brain aging and increasing the risk of dementia. The Environmental-Pollution-Induced Neurological Effects study is a multi-city prospective cohort study aiming to comprehensively investigate the effect of different environmental pollutants on brain structures, neuropsychological function, and the development of dementia in adults. The baseline data of 3,775 healthy elderly people were collected from August 2014 to March 2018. The eligibility criteria were age ≥50 years and no self-reported history of dementia, movement disorders, or stroke. The assessment included demographics and anthropometrics, laboratory test results, and individual levels of exposure to air pollution. A neuroimaging sub-cohort was also recruited with 1,022 participants during the same period, and brain magnetic resonance imaging and neuropsychological tests were conducted. The first follow-up environmental pollutant measurements will start in 2022 and the follow-up for the sub-cohort will be conducted every 3-4 years. We have found that subtle structural changes in the brain may be induced by exposure to airborne pollutants such as particulate matter 10 μm or less in diameter (PM10), particulate matter 2.5 μm or less in diameter (PM2.5) and Mn10, manganese in PM10; Mn2.5, manganese in PM2.5. PM10, PM2.5, and nitrogen dioxide in healthy adults. This study provides a basis for research involving large-scale, long-term neuroimaging assessments in community-based populations.

Summary

Korean summary
EPINEF 코호트는 환경유해인자에 의한 신경계 질환의 위해성을 평가하고, 환경유해인자로 유발되는 신경심리학적 기능 저하 또는 뇌 노화에 대한 근거를 제공하기 위해 2014년부터 50세 이상의 건강한 성인을 대상으로 시작되었습니다. 본 코호트는 뇌 영상학적 표지자와 인지 기능과 관련된 환경유해인자를 광범위하게 조사한 한국 최초의 장기 추적관찰 연구로, 대기 오염 물질 또는 다환방향족탄화수소 노출이 대뇌 영상표지자 및 신경심리학적 기능, 노인의 우울 증상에 대한 악화 요인으로서의 대기오염물질 노출과 결혼 상태의 교호작용 등의 연구결과들을 발표하였습니다. 또한, 추후에도 코호트의 지속적인 추적을 통해 환경유해인자 노출에 따른 신경학적 건강영향을 연구하여, 신경계 질환 관리를 위한 보건 정책 개선에 기여할 수 있을 것으로 기대됩니다.

Key Message
The EPINEF cohort was started in 2014 to assess the risk of neurological diseases caused by environmental harmful factors and to provide evidence for neuropsychological dysfunction or brain aging induced by these factors. This cohort is the first long-term follow-up study in Korea to extensively investigate brain imaging markers and environmental harmful factors related to cognitive function, and several related research results have been published. In addition, the follow-up survey will be continued in the future, and we expect that the results of the study will contribute to improving health policies for the management of neurological diseases.

Citations

Citations to this article as recorded by

Associations of Particulate Matter Exposures With Brain Gray Matter Thickness and White Matter Hyperintensities: Effect Modification by Low-Grade Chronic Inflammation
Jaelim Cho, Heeseon Jang, Young Noh, Seung-Koo Lee, Sang-Baek Koh, Sun-Young Kim, Changsoo Kim
Journal of Korean Medical Science.2023;[Epub] CrossRef
Polycyclic aromatic hydrocarbons and changes in brain cortical thickness and an Alzheimer's disease-specific marker for cortical atrophy in adults: A longitudinal neuroimaging study of the EPINEF cohort
Jaelim Cho, Jungwoo Sohn, Sung Hee Yang, Seung-Koo Lee, Young Noh, Sung Soo Oh, Sang-Baek Koh, Changsoo Kim
Chemosphere.2023; 338: 139596. CrossRef
Surveillance of long-term environmental elements and PM2.5 health risk assessment in Yangtze River Delta, China, from 2016 to 2020
Keqin Wu, Yuanhua Meng, Yan Gong, Xuhui Zhang, Linlin Wu, Xinliang Ding, Xiaofeng Chen
Environmental Science and Pollution Research.2022; 29(54): 81993. CrossRef
Reduced brain subcortical volumes in patients with glaucoma: a pilot neuroimaging study using the region-of-interest-based approach
Yae Won Ha, Heeseon Jang, Sang-Baek Koh, Young Noh, Seung-Koo Lee, Sang Won Seo, Jaelim Cho, Changsoo Kim
BMC Neurology.2022;[Epub] CrossRef

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