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Original article Mortality burden attributable to long-term exposure to fine particulate matter among older adults in South Korea
Jongmin Oh1,6orcid , Jisun Myung2orcid , Changwoo Han3orcid , Hyun Joo Bae4orcid , Soontae Kim5orcid , Yun-Chul Hong6orcid , Dong-Wook Lee2orcid , Youn-Hee Lim7orcid
Epidemiol Health 2025;e2025028
DOI: https://doi.org/10.4178/epih.e2025028 [Accepted]
Published online: May 28, 2025
1Ewha Womans University, Seoul, Korea
2Inha University, Incheon, Korea
3Chungnam National University, Daejeon, Korea
4Korea Environment Institute, Sejong, Korea
5Ajou University, Suwon, Korea
6Seoul National University, Seoul, Korea
7University of Copenhagen , Copenhagen, Denmark
Corresponding author:  Dong-Wook Lee,
Email: taesanglee89@gmail.com
Received: 17 February 2025   • Revised: 30 April 2025   • Accepted: 2 May 2025
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Abstract

OBJECTIVES
This study aimed to evaluate the association between long-term exposure to fine particulate matter (PM2.5) and cause-specific mortality among older adults in South Korea, providing insights into the evolving public health burden in an aging society.
METHODS
We analyzed national insurance claims data from the Republic of Korea spanning 2010–2019. Modeled PM2.5 concentrations were assigned to participants according to their residential districts. We employed time-varying Cox proportional hazard models, using age as the time scale, adjusted for potential confounders. Six cause-specific mortalities were considered: ischemic heart disease (IHD), stroke, chronic obstructive pulmonary disease (COPD), acute lower respiratory infection (ALRI), lung cancer (LC), and type 2 diabetes mellitus (T2DM). Annual excess deaths attributable to long-term PM2.5 exposure were calculated.
RESULTS
A total of 5,360,032 older adults were followed from 2010 to 2019. Hazard ratios (HRs) per 10 μg/m³ increase in 12-month PM2.5 concentration were as follows: IHD, 1.068 (95% CI, 1.040–1.097); stroke, 1.023 (95% CI, 1.003–1.043); ALRI, 1.050 (95% CI, 1.026–1.076); COPD, 1.114 (95% CI, 1.072–1.157); T2DM, 1.046 (95% CI, 1.007–1.086); and LC, 0.972 (95% CI, 0.948–0.996). Excess deaths attributable to long-term PM2.5 exposure were estimated at 4,888 (95% CI, 2,304–7,323) in 2010 and 5,179 (95% CI, 2,585–7,648) in 2019.
CONCLUSIONS
Although PM2.5 levels in South Korea have shown a declining trend over the past decade, mortality among older adults associated with long-term PM2.5 exposure has not significantly decreased, likely due to the rapid aging of the population.

Epidemiol Health : Epidemiology and Health
© Korean Society of Epidemiology.
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