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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
  • 6,156 View
  • 198 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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.

Citations

Citations to this article as recorded by  
  • Trends in the Use of Air Quality Indexes in Asthma Studies
    Angie Daniela Barrera-Heredia, Carlos Alfonso Zafra-Mejía, Alejandra Cañas Arboleda, María José Fernández Sánchez, Liliana López-Kleine, Adriana Rojas Moreno
    Atmosphere.2024; 15(7): 847.     CrossRef
  • Personal Strategies to Reduce the Cardiovascular Impacts of Environmental Exposures
    Luke J. Bonanni, Jonathan D. Newman
    Circulation Research.2024; 134(9): 1197.     CrossRef
Ambient air quality and subjective stress level using Community Health Survey data in Korea
Myung-Jae Hwang, Hae-Kwan Cheong, Jong-Hun Kim, Youn Seo Koo, Hui-Young Yun
Epidemiol Health. 2018;40:e2018028.   Published online June 28, 2018
DOI: https://doi.org/10.4178/epih.e2018028
  • 14,869 View
  • 211 Download
  • 9 Web of Science
  • 10 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Air pollution causes various disease in exposed populations, and can lead to premorbid health effects manifested as both physical and psychological functional impairment. The present study investigated the subjective stress level in daily life in relation to the level of air pollution.
METHODS
Data from the Community Health Survey (2013), comprising 99,162 men, and 121,273 women residing in 253 healthcare administrative districts, were combined with air pollutant concentration modelling data from the Korean Air Quality Forecasting System, and were stratified by subjective stress levels into five strata for multiple logistic regression. Levels of exposure were divided into five quintiles according to the annual concentration of nitrogen dioxide (NO2), and were analyzed using a single-pollutant model using NO2 concentration only, and a multi-pollutant model adjusted for the concentration of particulate matter <10 μm in diameter.
RESULTS
Analysis of men and women in various age groups showed the highest odds ratio (OR) for subjective stress level at the highest NO2 concentration quintile in men and women aged 30–64 years (men: 2.91; 95% confidence interval [CI], 2.12 to 4.01; women: 1.82; 95% CI, 1.32 to 2.51). As the NO2 concentration quintile increased, the OR increased. Men showed higher ORs than women in all strata.
CONCLUSIONS
In the present study, annual NO2 concentrations were found to be associated with subjective stress levels. This association was especially clear among socioeconomically active men and women aged 30-64 years.
Summary
Korean summary
2013년 지역사회건강조사를 이용하여 253개 보건행정지역단위로 Korean Air Quality Forecasting System (KAQFS) 대기물질농도 모델링자료를 결합하여 주관적 스트레스 정도에 따라 5분위로 범주화하여 다항로지스틱회귀을 하였다. 본 연구에서는 연평균 NO2농도와 주관적 스트레스 정도가 관련이 있는 것으로 나타났다. 특히, 사회 경제적 활동이 활발한30세 이상 65세 미만의 남성과 여성에서 관련성이 뚜렷하게 나타났다.

Citations

Citations to this article as recorded by  
  • High-Resolution Daily PM2.5 Exposure Concentrations in South Korea Using CMAQ Data Assimilation with Surface Measurements and MAIAC AOD (2015–2021)
    Jin-Goo Kang, Ju-Yong Lee, Jeong-Beom Lee, Jun-Hyun Lim, Hui-Young Yun, Dae-Ryun Choi
    Atmosphere.2024; 15(10): 1152.     CrossRef
  • Climate change and mental health in Korea: A scoping review
    Jiyoung Shin, Juha Baek, Sumi Chae
    Journal of Climate Change Research.2023; 14(6-2): 989.     CrossRef
  • Long-term air pollution exposure, greenspace and health-related quality of life in the ECRHS study
    Anne Boudier, Iana Markevych, Bénédicte Jacquemin, Michael J. Abramson, Simone Accordini, Bertil Forsberg, Elaine Fuertes, Judith Garcia-Aymerich, Joachim Heinrich, Ane Johannessen, Bénédicte Leynaert, Isabelle Pin, Valérie Siroux
    Science of The Total Environment.2022; 849: 157693.     CrossRef
  • The impact of black carbon (BC) on mode-specific galvanic skin response (GSR) as a measure of stress in urban environments
    Xiuleng Yang, Juan Pablo Orjuela, Emma McCoy, Guillem Vich, Esther Anaya-Boig, Ione Avila-Palencia, Christian Brand, Glòria Carrasco-Turigas, Evi Dons, Regine Gerike, Thomas Götschi, Mark Nieuwenhuijsen, Luc Int Panis, Arnout Standaert, Audrey de Nazelle
    Environmental Research.2022; 214: 114083.     CrossRef
  • Effects of ambient air pollution on psychological stress and anxiety disorder: a systematic review and meta-analysis of epidemiological evidence
    Tanwi Trushna, Vikas Dhiman, Dharma Raj, Rajnarayan R. Tiwari
    Reviews on Environmental Health.2021; 36(4): 501.     CrossRef
  • Green space, air pollution, traffic noise and saliva cortisol in children
    Lizan D. Bloemsma, Alet H. Wijga, Jochem O. Klompmaker, Gerard Hoek, Nicole A. H. Janssen, Marieke Oldenwening, Gerard H. Koppelman, Erik Lebret, Bert Brunekreef, Ulrike Gehring
    Environmental Epidemiology.2021; 5(2): e141.     CrossRef
  • Effects of exposure to ambient air pollution on pulmonary function impairment in Korea: the 2007-2017 Korea National Health and Nutritional Examination Survey
    Soo Beom Choi, Sungha Yun, Sun-Ja Kim, Yong Bum Park, Kyungwon Oh
    Epidemiology and Health.2021; 43: e2021082.     CrossRef
  • Impacts of ambient air pollution on glucose metabolism in Korean adults: a Korea National Health and Nutrition Examination Survey study
    Myung-Jae Hwang, Jong-Hun Kim, Youn-Seo Koo, Hui-Young Yun, Hae-Kwan Cheong
    Environmental Health.2020;[Epub]     CrossRef
  • A Development of PM Concentration Reanalysis Method using CMAQ with Surface Data Assimilation and MAIAC AOD in Korea
    Youn-Seo Koo, Dae-Ryun Choi, Hui-Young Yun, Geon-Woo Yoon, Joung-Beom Lee
    Journal of Korean Society for Atmospheric Environment.2020; 36(4): 558.     CrossRef
  • Short-Term Impacts of Ambient Air Pollution on Health-Related Quality of Life: A Korea Health Panel Survey Study
    Myung-Jae Hwang, Jong-Hun Kim, Hae-Kwan Cheong
    International Journal of Environmental Research and Public Health.2020; 17(23): 9128.     CrossRef

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