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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.
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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.
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.
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) |
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)
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)
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