한국환경보건학회지 (Journal of Environmental Health Sciences)

  • 제45권1호
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  • Pages.30-41
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  • 2019
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  • 1738-4087(pISSN)
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  • 2233-8616(eISSN)
한국환경보건학회 (Korean Society of Environmental Health)
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미세먼지와 오존노출에 의한 노인의 의료 이용 영향에 대한 연구

A Study on the Influence on Medical Care for the Elderly by Exposure to Fine Particulate Matter and Ozone

  • 정은주 (아주대학교 의과대학 예방의학교실) ;
  • 나원웅 (SK 하이닉스 SHE 연구소) ;
  • 이경은 (안전보건공단 산업안전보건연구원) ;
  • 장재연 (아주대학교 의과대학 예방의학교실)
  • Jung, En-Joo (Ajou University School of Preventive Medicine) ;
  • Na, Wonwoong (SK Hynix SHE R&D Center) ;
  • Lee, Kyung-Eun (Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency) ;
  • Jang, Jae-Yeon (Ajou University School of Preventive Medicine)
  • 투고 : 2019.01.04
  • 심사 : 2019.02.20
  • 발행 : 2019.02.28
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초록

Objectives: The effects of particulate matter and ozone on health are being reported in a number of studies. These effects are likely to be stronger on the elderly population, but studies in this regard are scarce. The purpose of this study was to examine the effects of particulate matter ${\leq}2.5{\mu}m$ and ozone on the acute health status of the elderly population. Methods: In order to analyze the health status of the elderly population, the NHIS-Senior Cohort data was used. In this study of people 60 years or older in Seoul, the number of outpatient visits and ER visits between 2002 and 2013 were calculated. Each disorder and the lag effect were analyzed separately. Particulate matter and ozone were analyzed using both the single exposure model and the adjusted multi-exposure model. Results: In the single exposure analysis with PM2.5 as the exposure variable, with each increase of $10{\mu}g/m^3$, the number of outpatient visits increased by 1.0081 times, vascular disease 1.0065 times, chronic pulmonary disease 1.0086 times, and diabetes 1.0055 times. In the multi-exposure model adjusting for ozone, the number of outpatient visits increased by 1.0066 times. There was a one-day lag effect and 1.0066 times increase between PM2.5 and ER visits in the multi-exposure model and 1.0057 times when adjusted for ozone (p value <0.10). There was a one-day lag effect in all multi-exposure models with ozone as the main variable, and when the particulate matter was adjusted, there was a one-day delay and 1.0143 times increase in ER visits. Conclusions: In our study, an increase in the number of outpatient and ER visits in the elderly population in accordance with the increase in PM2.5 and ozone was found. The association found in our study could also produce a socioeconomic burden. Future studies need to be performed in regards to younger populations and other air pollutants.

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참고문헌

  1. Linn WS, Szlachcic Y, Gong H, Patrick L. Air pollution and daily hospital admissions in metropolitan Los Angeles. Environmental Health Perspectives. 2000; 108(5): 427-434. https://doi.org/10.1289/ehp.00108427
  2. Shields KN, Cavallari JM, Hunt MJO, Lazo M, Molina M, Molina L, et al. Traffic-related air pollution exposures and changes in heart rate variability in Mexico City: a panel study. Environmental health: a global access science source. 2013; 12: 1-14.
  3. Tallon LA, Manjourides J, Pun VC, Mittleman MA, Kioumourtzoglou MA, Coull B, et al. Erectile dysfunction and exposure to ambient Air pollution in a nationally representative cohort of older Men. Environ Health. 2017; 16(12): 1-9. https://doi.org/10.1186/s12940-016-0208-y
  4. To T, Zhu J, Larsen K, Simatovic J, Feldman L, Ryckman K, et al. Progression from Asthma to Chronic Obstructive Pulmonary Disease. Is Air Pollution a Risk Factor? Am J Respir Crit Care Med. 2016; 194(4): 429-438. https://doi.org/10.1164/rccm.201510-1932OC
  5. Hao Y, Balluz L, Strosnider H, Wen XJ, Li C, Qualters JR. Ozone, Fine Particulate Matter, and Chronic Lower Respiratory Disease Mortality in the United States. Am J Respir Crit Care Med. 2015; 192(3): 337-341. https://doi.org/10.1164/rccm.201410-1852OC
  6. Yamazaki S, Shima M, Yoda Y, Oka K, Kurosaka F, Shimizu S, et al. Association between PM2.5 and primary care visits due to asthma attack in Japan: relation to Beijing's air pollution episode in January 2013. Environ Health Prev Med. 2014; 19(2): 172-176. https://doi.org/10.1007/s12199-013-0371-5
  7. Ensor KB, Raun LH, Persse D. A case-crossover analysis of out-of-hospital cardiac arrest and air pollution. Circulation. 2013; 127(11): 1192-1199. https://doi.org/10.1161/CIRCULATIONAHA.113.000027
  8. Morgan G, Corbett S, Wlodarczyk J. Air pollution and hospital admissions in Sydney, Australia, 1990 to 1994. American Journal of Public Health. 1998; 88(12): 1761-1766. https://doi.org/10.2105/AJPH.88.12.1761
  9. Tellez-Rojo MM, Romieu I, Ruiz-Velasco S, Lezana MA, Hernandez-Avila MM. Daily respiratory mortality and PM10 pollution in Mexico City: Importance of considering place of death. European Respiratory Journal. 2000; 16(3): 391-396. https://doi.org/10.1034/j.1399-3003.2000.016003391.x
  10. Di Q, Dai L, Wang Y, Zanobetti A, Choirat C, Schwartz JD, et al. Association of Short-term Exposure to Air Pollution With Mortality in Older Adults. JAMA. 2017; 318(24): 2446-2456. https://doi.org/10.1001/jama.2017.17923
  11. Wheida A, Nasser A, El Nazer M, Borbon A, Abo El Ata GA, Abdel Wahab M, et al. Tackling the mortality from long-term exposure to outdoor air pollution in megacities: Lessons from the Greater Cairo case study. Environ Res. 2018; 160: 223-231. https://doi.org/10.1016/j.envres.2017.09.028
  12. Orellano P, Quaranta N, Reynoso J, Balbi B, Vasquez J. Effect of outdoor air pollution on asthma exacerbations in children and adults: Systematic review and multilevel meta-analysis. PLoS One. 2017; 12(3): 1-15.
  13. Fann N, Lamson AD, Anenberg SC, Wesson K, Risley D, Hubbell BJ. Estimating the national public health burden associated with exposure to ambient PM2.5 and ozone. Risk Anal. 2012; 32(1): 81-95. https://doi.org/10.1111/j.1539-6924.2011.01630.x
  14. Schwartz J, Litonjua A, Suh H, Verrier M, Zanobetti A, Syring M, et al. Traffic related pollution and heart rate variability in a panel of elderly subjects. Thorax. 2005; 60(6): 455-461. https://doi.org/10.1136/thx.2004.024836
  15. Koken PJ, Piver WT, Ye F, Elixhauser A, Olsen LM, Portier CJ. Temperature, air pollution, and hospitalization for cardiovascular diseases among elderly people in Denver. Environ Health Perspect. 2003; 111(10): 1312-1317. https://doi.org/10.1289/ehp.5957
  16. Kim JH, Hong YC. GSTM1, GSTT1, and GSTP1 polymorphisms and associations between air pollutants and markers of insulin resistance in elderly Koreans. Environ Health Perspect. 2012; 120(10): 1378-1384. https://doi.org/10.1289/ehp.1104406
  17. Lim YH, Kim H, Kim JH, Bae S, Park HY, Hong YC. Air pollution and symptoms of depression in elderly adults. Environ Health Perspect. 2012. 120(7): 1023-1028. https://doi.org/10.1289/ehp.1104100
  18. Hong YC, Lee JT, Kim H, Ha EH, Schwartz J, Christiani DC. Effects of air pollutants on acute stroke mortality. Environmental Health Perspectives. 2002; 110(2): 187-191. https://doi.org/10.1289/ehp.02110187
  19. Goldberg MS, Burnett RT, Brook J, Bailar JC, Valois MF, Vincent R. Associations between daily cause-specific mortality and concentrations of ground-level ozone in Montreal, Quebec. American Journal of Epidemiology. 2001; 154(9): 8817-8826.
  20. Wong CM, Atkinson RW, Ross Anderson H, Hedley AJ, Stefan M, Chau PYK, et al. A tale of two cities: Effects of air pollution on hospital admissions in Hong Kong and London compared. Environmental Health Perspectives. 2002; 110(1): 67-77. https://doi.org/10.1289/ehp.0211067
  21. Martins LC, Pereira LAA, Lin CA, Santos UP, Prioli G, Luiz Odo C, et al. The effects of air pollution on cardiovascular diseases: lag structures. Revista de saude publica. 2006; 40(4): 677-683. https://doi.org/10.1590/S0034-89102006000500018
  22. Carlsen HK, Forsberg B, Meister K, Gislason T, Oudin A. Ozone is associated with cardiopulmonary and stroke emergency hospital visits in Reykjavik, Iceland 2003-2009. Environmental Health: A Global Access Science Source. 2013; 12(1): 1-8.
  23. Szyszkowicz M. Ambient air pollution and daily emergency department visits for ischemic stroke in Edmonton, Canada. Int J Occup Med Environ Health. 2008; 21(4): 295-300. https://doi.org/10.2478/v10001-008-0029-5
  24. Kan H, London SJ, Chen G, Zhang Y, Song G, Zhao N, et al. Season, sex, age, and education as modifiers of the effects of outdoor air pollution on daily mortality in Shanghai, China: The Public Health and Air Pollution in Asia (PAPA) Study. Environ Health Perspect. 2008; 116(9): 1183-1188. https://doi.org/10.1289/ehp.10851
  25. Cakmak S, Dales RE, Vidal CB. Air pollution and mortality in Chile: susceptibility among the elderly. Environ Health Perspect. 2007; 115(4): 524-527. https://doi.org/10.1289/ehp.9567
  26. Winquist A, Klein M, Tolbert P, Flanders WD, Hess J, Sarnat SE. Comparison of emergency department and hospital admissions data for air pollution timeseries studies. Environmental Health: A Global Access Science Source. 2012; 11(1): 1-14. https://doi.org/10.1186/1476-069X-11-1
  27. Wang Y, Zu Y, Huang L, Zhang H, Wang C, Hu J. Associations between daily outpatient visits for respiratory diseases and ambient fine particulate matter and ozone levels in Shanghai, China. Environ Pollut. 2018; 240: 754-763. https://doi.org/10.1016/j.envpol.2018.05.029
  28. Zheng XY, Ding H, Jiang LN, Chen SW, Zheng JP, Qiu M, et al. Association between Air Pollutants and Asthma Emergency Room Visits and Hospital Admissions in Time Series Studies: A Systematic Review and Meta-Analysis. PLoS One. 2015; 10(9): 1-24.
  29. Quan H, Sundararajan V, Halfon P, Burnand B, Luthi JC, Fong A, et al. Algorithms and for Defining Comorbidities Data in ICD-9-CM Administrative. Med Care. 2005; 43(11): 1130-1139. https://doi.org/10.1097/01.mlr.0000182534.19832.83
  30. Kim NR, Kim HC. Prevalence and Trends of Isolated Systolic Hypertension among Korean Adults: the Korea National Health and Nutrition Examination Survey, 1998-2012. Korean Circ J. 2015; 45(6): 492-499. https://doi.org/10.4070/kcj.2015.45.6.492
  31. Peng RE, Dominici F. Statistical Methods for Environmental Epidemiology with R. A Case Study in Air Pollution and Health, 1st ed. Springer; 2008. p.41-97.
  32. Lim YH, Park AK, Kim H. Modifiers of diurnal temperature range and mortality association in six Korean cities. International Journal of Biometeorology. 2012; 56(1): 33-42. https://doi.org/10.1007/s00484-010-0395-0
  33. Xu M, Guo Y, Zhang Y, Westerdahl D, Mo Y, Liang F, et al. Spatiotemporal analysis of particulate air pollution and ischemic heart disease mortality in Beijing, China. Environmental Health: A Global Access Science Source. 2014; 13(1): 1-12. https://doi.org/10.1186/1476-069X-13-1
  34. Ca M, Aj C, Ecol H, Access R. Pollution a l'ozone et survenue d'accidents vasculaires cerebraux a Dijon entre 1994 et 2004. Environnement, Risques & Sante. 2007; 6: 421-422.
  35. Fung KY, Khan S, Krewski D, Chen Y. Association between Air Pollution and Multiple Respiratory Hospitalizations among the Elderly in Vancouver, Canada. Inhalation Toxicology. 2006; 18(13): 1005-1011. https://doi.org/10.1080/08958370600904538
  36. Halonen JI, Lanki T, Tiittanen P, Niemi JV, Loh M, Pekkanen J. Ozone and cause-specific cardiorespiratory morbidity and mortality. J Epidemiol Community Health. 2010; 64(9): 814-820. https://doi.org/10.1136/jech.2009.087106
  37. Eckel SP, Louis TA, Chaves PH, Fried LP, Margolis AH. Modification of the association between ambient air pollution and lung function by frailty status among older adults in the Cardiovascular Health Study. Am J Epidemiol. 2012; 176(3): 214-223. https://doi.org/10.1093/aje/kws001
  38. Hong J, Zhong T, Li H, Xu J, Ye X, Mu Z, et al. Ambient air pollution, weather changes, and outpatient visits for allergic conjunctivitis: A retrospective registry study. Sci Rep. 2016; 6: 1-8. https://doi.org/10.1038/s41598-016-0001-8
  39. Buadong D, Jinsart W, Funatagawa I, Karita K, Yano E. Association Between PM10 and O3 Levels and Hospital Visits for Cardiovascular Diseases in Bangkok, Thailand. Journal of Epidemiology. 2009; 19(4): 182-188. https://doi.org/10.2188/jea.JE20080047
  40. Brook RD, Bard RL, Morishita M, Dvonch JT, Wang L, Yang HY, et al. Hemodynamic, autonomic, and vascular effects of exposure to coarse particulate matter air pollution from a rural location. Environ Health Perspect. 2014; 122(6): 624-630. https://doi.org/10.1289/ehp.1306595
  41. Chen S, Wu X, Hu J, Dai G, Rong A, Guo G. PM2.5 exposure decreases viability, migration and angiogenesis in human umbilical vein endothelial cells and human microvascular endothelial cells. Mol Med Rep. 2017; 16(3): 2425-2430. https://doi.org/10.3892/mmr.2017.6877
  42. Zhang X, Staimer N, Tjoa T, Gillen DL, Schauer JJ, Shafer MM, et al. Associations between microvascular function and short-term exposure to traffic-related air pollution and particulate matter oxidative potential. Environ Health. 2016; 15(1): 1-16. https://doi.org/10.1186/s12940-015-0085-9
  43. Beeson WL, Abbey DE, Knutsen SF. Long-term concentrations of ambient air pollutants and incident lung cancer in California adults: Results from the AHSMOG study. Environmental Health Perspectives. 1998; 106(12): 813-822. https://doi.org/10.2307/3434125
  44. Goldberg MS, Burnett RT, Stieb DM, Brophy JM, Daskalopoulou SS, Valois MF, et al. Associations between ambient air pollution and daily mortality among elderly persons in Montreal, Quebec. Sci Total Environ. 2013; 463-464: 931-942. https://doi.org/10.1016/j.scitotenv.2013.06.095
  45. Hystad P, Demers PA, Johnson KC, Brook J, Donkelaar AV, Lamsal L, et al. Spatiotemporal air pollution exposure assessment for a Canadian population-based lung cancer case-control study. Environ Health. 2012; 11: 1-13. https://doi.org/10.1186/1476-069X-11-1
  46. Lin H, Guo Y, Zheng Y, Di Q, Liu T, Xiao J, et al. Long-Term Effects of Ambient PM2.5 on Hypertension and Blood Pressure and Attributable Risk Among Older Chinese Adults. Hypertension. 2017; 69(5): 806-812. https://doi.org/10.1161/HYPERTENSIONAHA.116.08839
  47. Orioli R, Cremona G, Ciancarella L, Solimini AG. Association between PM10, PM2.5, NO2, O3 and self-reported diabetes in Italy: A cross-sectional, ecological study. PLoS One. 2018; 13(1): 1-17.
  48. 문옥륜, 김창엽, 김명기. 동일 질환에 대한 상병분류기호의 의료기관별변이에 관한 연구. Korean J. of Health Policy a Administration. 1992; 2(1): 66-79.
  49. Xu Q, Li X, Wang S, Wang C, Huang F, Gao Q, et al. Fine Particulate Air Pollution and Hospital Emergency Room Visits for Respiratory Disease in Urban Areas in Beijing, China, in 2013. PLoS One. 2016; 11(4): 1-17.
  50. Cai J, Zhao A, Zhao J, Chen R, Wang W, Ha S, et al. Acute effects of air pollution on asthma hospitalization in Shanghai, China. Environ Pollut. 2014; 191: 139-144. https://doi.org/10.1016/j.envpol.2014.04.028
  51. Cai J, Chen R, Wang W, Xu X, Ha S, Kan H. Does ambient CO have protective effect for COPD patient? Environ Res. 2015; 136: 21-26. https://doi.org/10.1016/j.envres.2014.09.039
  52. Cao J, Li W, Tan J, Song W, Xu X, Jiang C, et al. Association of ambient air pollution with hospital outpatient and emergency room visits in Shanghai, China. Sci Total Environ. 2009; 407: 5531-5536. https://doi.org/10.1016/j.scitotenv.2009.07.021
  53. Chen R, Chu C, Tan J, Cao J, Song W, Xu X, et al. Ambient air pollution and hospital admission in Shanghai, China. J Hazard Mater. 2010; 181: 234-240. https://doi.org/10.1016/j.jhazmat.2010.05.002
  54. Hua J, Yin Y, Peng L, Du L, Geng F, Zhu L. Acute effects of black carbon and PM2.5 on children asthma admissions: a time-series study in a Chinese city. Sci Total Environ. 2014; 481: 433-438. https://doi.org/10.1016/j.scitotenv.2014.02.070
  55. Huang W, Tan J, Kan H, Zhao N, Song W, Song G, et al. Visibility, air quality and daily mortality in Shanghai, China. Sci Total Environ. 2009; 407: 3295-3300. https://doi.org/10.1016/j.scitotenv.2009.02.019
  56. Kan H, Chen B. A case-crossover analysis of air pollution and daily mortality in Shanghai. J Occup Health. 2003; 45: 119-124. https://doi.org/10.1539/joh.45.119
  57. Kan H, London SJ, Chen G, Zhang Y, Song G, Zhao N, et al. Differentiating the effects of fine and coarse particles on daily mortality in Shanghai, China. Environ Int. 2007; 33: 376-384. https://doi.org/10.1016/j.envint.2006.12.001
  58. Zhao W, Cheng J, Li D, Duan Y, Wei H, Ji R, et al. Urban ambient air quality investigation and health risk assessment during haze and nonehaze periods in Shanghai, China. Atmospheric Pollution Research. 2013; 4: 275-281. https://doi.org/10.5094/APR.2013.030