Journal List > J Korean Soc Hypertens > v.17(2) > 1089784

Ha, Suh, Kang, Kim, Shin, and Kim: Ambient Particulate Matter and the Risk of Deaths from Cardiovascular and Cerebrovascular Disease

ABSTRACT

Background:

To assess the association between ambient particulate matter and cardiovascular death in seven cities in the Republic of Korea during the period of 2002-2008.

Methods:

A time-stratified case-crossover design was used to examine association between particulate matter and deaths from cardiovascular or cerebrovascular disease; hypertensive disease 12,821, ischemic heart disease 39,577, cardiac arrhythmia 1,627, cerebrovascular disease 88,047. Mortality data was obtained from National Statistical Office, and hourly mean concentrations of particulate matter ≤ 10 µm in aerodynamic diameter and meteorological data were obtained from the Ministry of Environment. The percent increase in the risk of death associated with an interquartile range increase in particulate matter was determined by conditional logistic regression analysis after adjusting for national holidays and meteorological factors.

Results:

The largest association was a 0.8% increase (95% confidence interval [CI], 0.1–1.6) in death risk related to an interquartile range increase in particulate matter ≤ 10 µm (average of 0 to 2 days prior to the day of death). Classified as the cause of death, the association was a 1.2% increase (95% CI, 0.2–2.2) in death from cerebrovascular disease related to an interquartile range increase in particulate matter ≤ 10 µm. But others were statistically not significant. After stratification of death cases by year of death, statistically significant associations were a 2.3% increase (95% CI, 0.1–4.4) in death risk from ischemic heart disease in 2002–2004 and 2.0% increase in death from cerebrovascular disease (95% CI, 0.3–3.8) in 2006–2008.

Conclusions:

Our results suggest that ambient air pollution increases the risk of deaths from cardiovascular and cerebrovascular disease in the Republic of Korea.

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Fig. 1.
Daily average concentration of particulate matter (left) and air temperature (right) in seven cities, 2002-2008. The lines drawn are nonparametric smooths (natural cubic spline) of the data.
jksh-17-74f1.tif
Fig. 2.
Random-effects estimates of change in deaths cardiovascular and cerebrovascular disease associated with an interquartile range increase in particulate matter. The day of death and 1, 2, and 3 days prior to the day of death from circulatory system disease were described as lag 0, lag 1, lag 2, and lag 3, respectively. Cumulative lag refers to cumulative lagged exposure, that is, the mean particulate matter concentrations on the specified day and all subsequent days. The interquartile range (IQR) was 39.05 µg/m3 for 10 µg particulate matter. Dots indicate the percent increase in death, and whiskers indicate 95% confidence intervals.
jksh-17-74f2.tif
Table 1.
General characteristics of the study subjects in 2002-2008
Deaths from cardiovascular and cerebrovascular disease
Period Ⅰ Period Ⅱ Total
(2002-2004) (2006-2008)
Characteristic n=69,519 n=68,341 n=160,273
Sex of death
Men 33,703 (48.5) 33,126 (48.5) 77,710 (48.5)
Women 35,816 (51.5) 35,215 (51.5) 82,563 (51.5)
Age at death
40-64 yr 17,649 (25.4) 13,987 (20.5) 36,894 (23.0)
≥65 yr 51,870 (74.6) 54,354 (79.5) 123,379 (77.0)
Region of death
Seoul 27,757 (39.9) 26,427 (38.7) 63,199 (39.4)
Incheon 8,241 (11.9) 8,247 (12.1) 19,045 (11.9)
Daejeon 4,161 (6.0) 3,984 (5.8) 9,397 (5.9)
Daegu 7,935 (11.4) 8,022 (11.7) 18,503 (11.5)
Ulsan 2,745 (4.0) 2,911 (4.3) 6,607 (4.1)
Gwanju 3,547 (5.1) 3,732 (5.5) 8,418 (5.3)
Busan 15,133 (21.8) 15,018 (22.0) 35,104 (21.9)
Disease of death
Death from hypertensive disease 5,251 (7.6) 5,843 (8.6) 12,821 (8.0)
Death from ischemic heart disease 15,951 (22.9) 17,955 (26.3) 39,577 (24.7)
Death from cardiac arrhythmia 476 (0.7) 915 (1.3) 1,627 (1.0)
Death from cerebrovascular disease 40,748 (58.6) 34,962 (51.2) 88,047 (54.9)
Others* 7,093 (10.2) 8,666 (12.7) 18,201 (11.4)

Values are presented as a number (%).

* None of four disease categories: Hypertensive disease, ischemic heart disease, cardiac arrhythmia and cerebrovascular disease.

Table 2.
Random-effects estimate of change in the risk of death associated with an interquartile range increase in particulate matter after stratification by subgroup (cumulative lag 1 and cumulative lag 2)
% Increase (95% confidence intervals) for death
Total Sex
Men Women
Cumulative lag 1
Death from hypertensive disease ‐0.7 (‐3.0 – 1.7) ‐0.6 (‐4.8 – 3.8) ‐0.5 (-3.3 – 2.5)
Death from ischemic heart disease 1.1 (‐0.2 – 2.4) 0.5 (‐1.3 – 2.2) 1.7 (-0.1 – 3.6)
Death from cardiac arrhythmia ‐7.4 (‐16.0 – 2.0) ‐7.9 (‐18.2 – 3.6) ‐7.5 (-17.1 – 3.2)
Death from cerebrovascular disease 0.8 (0.0 – 1.6) 0.5 (‐0.7 – 1.7) 1.1 (-0.1 – 2.3)
Cumulative lag 2
Death from hypertensive disease ‐1.5 (‐4.2 – 1.3) ‐0.6 (‐5.4 – 4.6) ‐1.9 (-5.2 – 1.6)
Death from ischemic heart disease 1.1 (‐0.4 – 2.6) 0.5 (‐1.7 – 2.8) 1.4 (-0.9 – 3.6)
Death from cardiac arrhythmia ‐6.4 (‐17.3 – 6.0) ‐8.7 (‐21.2 – 5.7) ‐4.7 (-17.0 – 9.4)
Death from cerebrovascular disease 1.2 (0.2 – 2.2) 1.1 (‐0.4 – 2.5) 1.4 (0.0 – 2.8)

* The interquartile range was 39.05 µg/m3 for 10 µg particulate matter.

Table 3.
Random-effects estimate of change in the risk of death associated with an interquartile range increase in particulate matter after stratification by subgroup and year (cumulative lag 2)
% Increase (95% confidence intervals) for death
Period I (2002-2004) Period II (2006-2008)
Death from circulatory system disease 0.5 (‐0.5 – 1.6) 0.9 (‐0.5 – 2.4)
Death from hypertensive disease ‐2.2 (‐6.1 – 1.8) ‐0.9 (‐5.2 – 3.6)
Death from ischemic heart disease 2.3 (0.1 – 4.4) ‐0.4 (‐2.8 – 2.0)
Death from cardiac arrhythmia 16.1 (‐15.3 – 59.1) ‐11.3 (‐29.7 – 11.9)
Death from cerebrovascular disease 0.4 (‐1.4 – 2.2) 2.0 (0.3 – 3.8)

* The interquartile range was 39.05 µg/m3 for 10 µg particulate matter.

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