Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지

Relationship between the Exposure to Ozone in Seoul and the Childhood Asthma-related Hospital Admissions according to the Socioeconomic Status

사회경제수준에 따른 오존과 소아천식 관련 입원의 상관성 연구

  • Son, Ji-Young (Department of Epidemiology & Biostatistics, School of Public Health and Institute of Health and Environment, Seoul National University) ;
  • Kim, Ho (Department of Epidemiology & Biostatistics, School of Public Health and Institute of Health and Environment, Seoul National University) ;
  • Kim, Sun-Young (Department of Epidemiology & Biostatistics, School of Public Health and Institute of Health and Environment, Seoul National University) ;
  • Lee, Jong-Tae (Department of Public Health and Management, and Institute of Environmental and Industrial Medicine, Hanyang University)
  • 손지영 (서울대학교 보건대학원) ;
  • 김호 (서울대학교 보건대학원) ;
  • 김선영 (서울대학교 보건대학원) ;
  • 이종태 (한양대학교 환경 및 산업의학연구소)
  • Published : 2006.01.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: A number of studies have reported associations between the ambient air pollution concentrations and various health outcomes. Especially, ozone is well known for primary risk factor of asthma attacks. The results of a recent study indicate that the size of the effect on health outcomes due to air pollution varied according to several conditions, including age, gender, race and the socioeconomic status. Therefore, this study was conducted to examine the associations of ozone with the childhood asthma hospitalizations as stratified by the socioeconomic status (SES) at the community level in Seoul, Korea, 2002. Methods: SES at aggregated levels was measured on the basis of average regional health-insurance rate per citizen in the area. We applied the generalized additive model to analyze the effect of ozone on asthma after controlling for the potential confounding variables that were capable of influencing the results. Results: Our analysis showed that the number of children who were hospitalized for asthma increased as the SES of the residence area decreased. The estimated relative risks of hospitalization for asthma, as stratified by the SES of the community level, were 1.12 (95% confidence interval 1.00-1.25) in districts with the highest SES levels, 1.24 (95% CI=1.08-1.43) within the moderate SES levels, and 1.32 (95% CI=1.11-1.58) in the districts with the lowest SES levels. Conclusions: Our analysis showed that exposure to air pollution did not equally affect the health status of individuals. This suggests that not only the biological-sensitivity markers, but also the SES of the subjects should be considered as potentially confounding factors.

Keywords

References

  1. Schwartz J, Dockery DW. Increased mortality in Philadelphia associated with daily air pollution concentrations. Am Rev Respir Dis 1992; 145: 600-604 https://doi.org/10.1164/ajrccm/145.3.600
  2. Lee JT, Schwartz J. Reanalysis of the effect of air pollution on daily mortality in Seoul, Korea: A case-crossover design. Environ Health Perspect 1999; 107(8): 633-636 https://doi.org/10.1289/ehp.99107633
  3. Schwartz J. Air pollution and hospital admissions for the elderly in Birmingham, Alabama. Am J Epidemiol 1994; 139: 589-598 https://doi.org/10.1093/oxfordjournals.aje.a117048
  4. Metzger KB, Tolbert PE, Klein M, Peel JL, Flanders WD, Todd K, Mulholland JA, Ryan PB, Frumkin H. Ambient air pollution and cardiovascular emergency department visits. Epidemiology 2004; 15: 46-56 https://doi.org/10.1097/01.EDE.0000101748.28283.97
  5. Koenig JQ, Larson TV, Hanley Qs, Rebolledo V, Dumler K, Checkoway H, Wang SZ, Lin D, Pierson WE. Pulmonary function changes in children associated with fine particulate matter. Environ Res 1993; 63: 26-38 https://doi.org/10.1006/enrs.1993.1123
  6. Nafstad P, Haheim LL, Oftedal B, Gram F, Holme I, Hjermann I, Leren P. Lung cancer and air pollution: A 27 year follow up of 16209 Norwegian man. Thorax 2003; 58: 1071-1076 https://doi.org/10.1136/thorax.58.12.1071
  7. Ha EH, Hong YC, Lee BE, Woo BH, Schwartz J, Christiani DC. Is Air Pollution a risk factor for low birth weight in Seoul? Epidemiology 2001; 12(6): 643-648 https://doi.org/10.1097/00001648-200111000-00011
  8. Ha EH, Lee JT, Kim H, Hong YC, Lee BE, Park HS, Christiani DC. Infant susceptibility of mortality to air pollution in Seoul, South Korea Pediatrics 2003; 111(2): 284-290
  9. Lee JT, Kim H, Song H, Hong YC, Cho YS, Shin SY. Air pollution and asthma among children in Seoul, Korea Epidemiology 2002; 13: 481-484 https://doi.org/10.1097/00001648-200207000-00018
  10. Gent JF, Triche EW, Holford TR, Belanger K, Bracken MB, Beckett WS, Leaderer BP. Association of low-level ozone and fine particles with respiratory symptoms in children with asthma. JAMA 2003; 290(14): 1859-1867 https://doi.org/10.1001/jama.290.14.1859
  11. Chen LL, Tager IB, Peden DB, Christian DL, Ferrando RE, Welch BS, Balmes JR Effect of ozone exposure on airway responses to inhaled allergen in asthmatic subjects. Chest 2004; 125(6): 2328-2335 https://doi.org/10.1378/chest.125.6.2328
  12. Gouveia N, Fletcher T. Time series analysis of air pollution and mortality: effects by cause, age and socioeconomic status, J Epidemiol Community Health 2000; 54(10): 750-755 https://doi.org/10.1136/jech.54.10.750
  13. Zanobetti A, Schwartz J. Race, gender and social status as modifiers of the effects of $PM_{10}$ on mortality, J Occup Environ 2000; 42(5): 469-474 https://doi.org/10.1097/00043764-200005000-00002
  14. Lynch JW, Smith GD, Kaplan GA, House JS. Income inequality and mortality: importance to health of individual income, psycosocial environment, or material conditions. BMJ 2000; 320: 1200-1204 https://doi.org/10.1136/bmj.320.7243.1200
  15. Chae SM. Equity in health care utilization attributable to socio-economic status in asthma outpatients [dissertation]. Korea: Seoul National Univ; 2005 (Korean)
  16. O'Neill Ms, Jerrett M, Kawachi I, Levy JI, Cohen AJ, Gouveia N, Wilkinson P, Fletcher P, Cifuentes L, Schwartz J. Health, wealth, and air pollution: Advancing theory and method, Environ Health Perspect 2003; 111(16): 1861-1870 https://doi.org/10.1289/ehp.6334
  17. Finkelstein MM, Jerrett M, Deluca P, Finkelstein N, Verma DK, Chapman K, Malcolm R. Sears relation between income, air pollution and mortality: A cohort study. CMAJ 2003; 169(5): 397-402
  18. Lin M, Chen Y, Villeneuve PJ, Burnett RT, Lemyre L, Hertzman C, McGrail KM. 2004. gaseous air pollutants and asthma hospitalization of children with low household income in Vancouver, British Columbia, Canada Am J Epidemiol 2004; 159: 294-303 https://doi.org/10.1093/aje/kwh043
  19. Carr W, Zeital L, Weiss K. Variations in asthma hospitalizations and death in New York city. Am J Public Health 1992; 82: 59-65 https://doi.org/10.2105/AJPH.82.1.59
  20. Jones AP, Bentham G. Health services accessibility and deaths from asthma in 401 local authority district in England and Wales, 1988-92. Thorax 1997; 52: 218-222 https://doi.org/10.1136/thx.52.3.218
  21. Wissow LS, Gittelsohn AM, Szklo M, Starfield B, Mussman M. Poverty, race and hospitalization for childhood asthma. Am J Public Health 1988; 78(7): 777-782 https://doi.org/10.2105/AJPH.78.7.777
  22. Xavier B, Jordi S, Manolis K, Jan-Paul Zock, Enric Duran-Tauleria, Deborah J, Peter Burney, and Josep Maria Anto on behalf of the European community respiratory health survey 1. Socioeconomic status and asthma prevalence in young adults. Am J Epidemiol 2004; 160: 178-188 https://doi.org/10.1093/aje/kwh186
  23. Litonjua AA, Carey VJ, Weiss ST, Gold DR. Race, socioeconomic factors, and area of residence are associated with asthma prevalence. Pediatr Pulmonol 1999; 28: 394-401 https://doi.org/10.1002/(SICI)1099-0496(199912)28:6<394::AID-PPUL2>3.0.CO;2-6
  24. Lewis SA, Weiss ST, Platts-Mills TA, Syring M, Gold DR. Association of specific allergen sensitization with socioeconomic factors and allergic disease in a population of Boston women. J Allergy Clin Immunol 2001; 107: 615-622 https://doi.org/10.1067/mai.2001.113523
  25. Montnemery P, Bengtsson P, Elliot A, Lindholm LH, Nyberg P, Lofdahl CG. Prevalence of obstructive lung disease and respiratory symptoms in relation to living environment and socio-economic group. Respir Med 2001; 95: 744-752 https://doi.org/10.1053/rmed.2001.1129
  26. Chen JT, Krieger N, Van Den Eeden SK, Charles P. Quesenberry. Different slopes for different folks: socioeconomic and racial/ethnic disparities in asthma and hay fever among 173,859 U.S. men and women. Environ Health Perspect 2002; 110(suppl2): 211-216 https://doi.org/10.1289/ehp.02110211
  27. Son M, Oh SY, Bae SS, Paek D, Moon OR. The relationship of occupational class, educational level and deprivation with mortality in Korea. Korean J Prev Med 2002; 35(1): 76-82 (Korean)
  28. Yang JI. A study on the correlation analysis between the air quality and income spatially in Seoul [dissertation]. Korea: Seoul National Univ; 1992 (Korean)
  29. Pope CA, Kalkstein LS. Synoptic weather modeling and estimates of the exposureresponse relationship between daily morality and particulate air pollution. Environ Health Perspect 1996; 104: 414-420 https://doi.org/10.2307/3432686
  30. Pope CA, Schwartz J. Time series for the analysis of pulmonary health data. Am J Respir Crit Care Med 1996; 154: S229-S233 https://doi.org/10.1164/ajrccm/154.6_Pt_2.S229
  31. Cho YS, Kim H, Lee JT, Hyun YJ and Kim YS. Relationship between exposure to air pollutants and aggravation of childhood asthma: a meta-analysis. J KOSAE 2001; 17(5); 425-437 (Korean)
  32. Samet JM, Zeger SL, Berhane K. The association of mortality and particulate air pollution. In 'particulate air pollution and daily mortality: replication and validation of selected studies (The Phase I.A Report of the Particle Epidemiology Evaluation Project).' Health Effect Institute, Cambridge, MA
  33. Neas L, Dockery Dw, Koutrakis P, Tollerud DJ, Speizer FE. The association of ambient air pollution with twice daily peak expiratory flow measurements in children. Am J Epidemiol 1995; 141: 111-122 https://doi.org/10.1093/oxfordjournals.aje.a117399
  34. Ostro BD, Lipsett MJ, Mann JK, Braxton-Owens H, White MC Air pollution and asthma exacerbations among African-American children in Los Angeles. Inhal Toxicol 1995; 7: 711-722 https://doi.org/10.3109/08958379509014475
  35. Jorres R, Norwak D, Magnussen H. The effect of ozone exposure on allergen responsiveness in subjects with ashtrna or rhinitis. Am J Respir Crit Care Med 1996; 153: 56-64 https://doi.org/10.1164/ajrccm.153.1.8542163
  36. Molfino NA, Wright SC, Katz I, Tarlo S, Silverman F, McClean PA, Szalai JP, Raizenne M, Slusky AS, Zamel N. Effect of low concentrations of ozone on inhaled allergen responses in asthmaitc subjects. Lancet 1991; 338: 199-203 https://doi.org/10.1016/0140-6736(91)90346-Q
  37. Kawachi I, Berkman L. 2003 Neighborhoods and Health. New York: Oxford University Press
  38. Lee JT, Dockery DW, Kim CB, Jee SH, Chung Y. A meta-analysis of ambient air pollution in relation to daily mortality in Seoul, 1991-1995. Korean J Prev Med 1999; 32(2): 177-182 (Korean)
  39. Grundy E, Holt G. The socio-economic status of older adults: how should we measure it in studies of health inequalities? J Epidemiol Community Health 2001; 55: 895-904 https://doi.org/10.1136/jech.55.12.895
  40. Adler NE, Boyce T, Chesney MA, Cohen S, Folkman S, Kahn R, Syme SL. Socioeconomic status and health, the challenge of the gradient. Am Psychol 1994; 49: 15-24 https://doi.org/10.1037/0003-066X.49.1.15