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1 "Ho-Jang Kwon"
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Original Article
Effect modification of consecutive high concentration days on the association between fine particulate matter and mortality: a multi-city study in Korea
Hyungryul Lim, Sanghyuk Bae, Jonghyuk Choi, Kyung-Hwa Choi, Hyun-Joo Bae, Soontae Kim, Mina Ha, Ho-Jang Kwon
Epidemiol Health. 2022;44:e2022052.   Published online June 9, 2022
DOI: https://doi.org/10.4178/epih.e2022052
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Although there is substantial evidence for the short-term effect of fine particulate matter (PM<sub>2.5</sub>) on daily mortality, few epidemiological studies have explored the effect of prolonged continuous exposure to high concentrations of PM<sub>2.5</sub>. This study investigated how the magnitude of the mortality effect of PM<sub>2.5</sub> exposure is modified by persistent exposure to high PM<sub>2.5</sub> concentrations.
METHODS
We analyzed data on the daily mortality count, simulated daily PM<sub>2.5</sub> level, mean daily temperature, and relative humidity level from 7 metropolitan cities from 2006 to 2019. Generalized additive models (GAMs) with quasi-Poisson distribution and random-effects meta-analyses were used to pool city-specific effects. To investigate the effect modification of continuous exposure to prolonged high concentrations, we applied categorical consecutive-day variables to the GAMs as effect modification terms for PM<sub>2.5</sub>.
RESULTS
The mortality risk increased by 0.33% (95% confidence interval [CI], 0.16 to 0.50), 0.47% (95% CI, -0.09 to 1.04), and 0.26% (95% CI, -0.08 to 0.60) for all-cause, respiratory, and cardiovascular diseases, respectively, with a 10 μg/m3 increase in PM<sub>2.5</sub> concentration. The risk of all-cause mortality per 10 μg/m3 increase in PM<sub>2.5</sub> on the first and fourth consecutive days significantly increased by 0.63% (95% CI, 0.20 to 1.06) and 0.36% (95% CI, 0.01 to 0.70), respectively.
CONCLUSIONS
We found increased risks of all-cause, respiratory, and cardiovascular mortality related to daily PM<sub>2.5</sub> exposure on the day when exposure to high PM<sub>2.5</sub> concentrations began and when exposure persisted for more than 4 days with concentrations of ≥35 μg/m3. Persistently high PM<sub>2.5</sub> exposure had a stronger effect on seniors.
Summary
Korean summary
한국의 7개 대도시를 배경으로 수행한 본 시계열 연구를 통하여 2006년부터 2019년까지의 기간 동안에 초미세먼지의 단기 노출이 일별 사망률을 증가시키며, 교호작용모형을 통해 일평균 35 μg/m3 이상의 고농도 지속기간이 처음 시작되는 날과 넷째 지속일에 이러한 사망효과가 커짐을 보고하였다. 이러한 고농도 지속기간의 교호작용은 65세 이상 연령군에서 더욱 두드러졌다.
Key Message
With our Korean multi-city study design from 2006 to 2019, the short-term effects of PM2.5 on mortality were greater when the high PM2.5 concentration duration began during the day and lasted for approximately 4 days, and the elderly may be more affected by persistently high PM2.5.

Epidemiol Health : Epidemiology and Health