Effect modification of consecutive high concentration days on the association between fine particulate matter and mortality: a multi-city study in Korea

Lim, Hyungryul; Bae, Sanghyuk; Choi, Jonghyuk; Choi, Kyung-Hwa; Bae, Hyun-Joo; Kim, Soontae; Ha, Mina; Kwon, Ho-Jang

doi:2022.44.0.e2022052

Epidemiol Health > Volume 44; 2022 > Article

Original Article

Epidemiology and Health 2022;44: e2022052-0.
DOI: https://doi.org/10.4178/epih.e2022052 Published online Jun 9, 2022.

Effect modification of consecutive high concentration days on the association between fine particulate matter and mortality: a multi-city study in Korea

¹Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
²Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
³Korea Environment Institute, Sejong, Korea
⁴Department of Environmental and Safety Engineering, Ajou University, Suwon, Korea

Correspondence Ho-Jang Kwon ,Email: hojangkwon@gmail.com

Received: Feb 18, 2022 Accepted after revision: Jun 9, 2022

Abstract

OBJECTIVES:
Although there is substantial evidence for the short-term effect of fine particulate matter (PM_2.5) on daily mortality, few epidemiological studies have explored the effect of prolonged continuous exposure to high concentrations of PM_2.5. This study investigated how the magnitude of the mortality effect of PM_2.5 exposure is modified by persistent exposure to high PM_2.5 concentrations.
METHODS:
We analyzed data on the daily mortality count, simulated daily PM_2.5 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 PM_2.5.
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 PM_2.5 concentration. The risk of all-cause mortality per 10 μg/m3 increase in PM_2.5 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 PM_2.5 exposure on the day when exposure to high PM_2.5 concentrations began and when exposure persisted for more than 4 days with concentrations of ≥35 μg/m3. Persistently high PM_2.5 exposure had a stronger effect on seniors.

Keywords: Air pollution, Particulate matter, Epidemiology, Mortality, Time-series analysis