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Air pollution, socioeconomic position, and emergency hospital visits for asthma in Seoul, Korea

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Abstract

Objective

Some epidemiological literature has observed that air pollution effects on health differed across regional or individual socioeconomic position. This study evaluated whether regional and individual socioeconomic position, as indicated by health insurance premiums, modified the effect of air pollution on hospital visits for asthma.

Methods

Effects of ambient air pollutants (particulate matter, carbon monoxide, sulfur dioxide, nitrogen dioxide, and ozone) on 92,535 emergency out-patient hospital visits for asthma in Seoul, Korea during 2002 were estimated using case-crossover analysis, adjusting for time trend, weather conditions, and seasonality. Next, interactions between air pollutants and Korean National Health Insurance premium (1) for the individual patient and (2) averaged across the patient’s residence district, were entered, first singly then jointly, in the models.

Results

Relative risks of emergency outpatient hospital visits were all positively and significantly associated with interquartile increases for selected lags for all air pollutants. In the regression model with interaction terms for both individual premium and regional-average premium, associations with all five-air pollutants ranged from 1.03 to 1.09 times higher among the lowest premium districts compared to the highest premium districts. Of all the pollutants, nitrogen dioxide showed the strongest associations in lower premium districts compared to the higher premium districts. Individual socioeconomic position did not modify the associations in either the single or joint interaction models.

Conclusion

In Seoul, community but not individual socioeconomic conditions modified risk of asthma hospital visits on high air pollution days.

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Abbreviations

CI:

Confidence interval

CO:

Carbon monoxide

KNHI:

Korean National Health Insurance

NO2 :

Nitrogen dioxide

PM10 :

Particulate matter ≤10 μm in aerodynamic diameter

REM:

Relative effect modification

RR:

Relative risk

SEP:

Socioeconomic position

SO2 :

Sulfur dioxide

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Acknowledgments

This study was supported by the grant from the Basic Research Program of Korea Science and Engineering Foundation (no. R01-2002-000-00554-0), the Korean Research Foundation Grant funded by the Korean Government (KRF-2005-214-E00041), and the Robert Wood Johnson Health and Society Scholars Program.

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Authors and Affiliations

  1. Department of Environment and Occupational Health Sciences, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA

    Sun-Young Kim

  2. Departments of Epidemiology and Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Marie S. O’Neill

  3. Department of Health Management, Graduate School, Hanyang University, Seoul, South Korea

    Jong-Tae Lee

  4. Department of Epidemiology and Biostatistics, Graduate School of Public Health and The Institute of Health and Environment, Seoul National University, Seoul, 110-799, South Korea

    Youngtae Cho & Ho Kim

  5. Primary Health Care Team, Research Department, Korea Health Insurance Review Agency, Seoul, South Korea

    Jaiyong Kim

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  1. Sun-Young Kim
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  2. Marie S. O’Neill
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  3. Jong-Tae Lee
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  4. Youngtae Cho
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  5. Jaiyong Kim
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  6. Ho Kim
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Correspondence to Ho Kim.

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Kim, SY., O’Neill, M.S., Lee, JT. et al. Air pollution, socioeconomic position, and emergency hospital visits for asthma in Seoul, Korea. Int Arch Occup Environ Health 80, 701–710 (2007). https://doi.org/10.1007/s00420-007-0182-3

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  • DOI: https://doi.org/10.1007/s00420-007-0182-3

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