Long-term Effects of Cumulative Average PM2.5 Exposure on the Risk of Hemorrhagic Stroke

Juhwan Noh, Jungwoo Sohn, Minkyung Han, Dae Ryong Kang, Yoon Jung Choi, HyeonChang Kim, Il Suh, Changsoo Kim, Dong Chun Shin

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Epidemiological studies have revealed associations between the fine particle (PM2.5; aerodynamic diameter <2.5 μm) exposure and cardiovascular disease. Researchers have also recently begun investigating the association between PM2.5 exposure and hemorrhagic stroke (HS) and identifying subpopulations vulnerable to PM2.5 exposure. Long-term cumulative average PM2.5 exposure may affect the risk of HS, and these effects may be modified by risk factors. METHODS: This retrospective study evaluated the effects of PM2.5 on the time-to-first-diagnosis of HS among 62,676 Seoul metropolitan city residents with 670,431 total person-years of follow-up; this cohort is a subset from a nationally representative cohort of 1,025,340 individuals from the Korean National Health Insurance Service database (2002-2013). A time-dependent Cox proportional hazards model was used to adjust for age, sex, household income, insurance type, body mass index, smoking status, medical history, and family history. The annual mean PM2.5 concentrations for 25 districts were used as the time-dependent variable. Subgroup analyses of the traditional risk factors of HS were performed to evaluate potential effect modifications. RESULTS: Each 10-μg/m increment in cumulative average PM2.5 exposure was noticeably associated with HS (hazard ratio [HR] = 1.43; 95% confidence interval [CI]: 1.09-1.88). The adverse effects of PM2.5 exposure were modified by ≥65 years of age (HR = 2.00; 95% CI = 1.32, 3.02) and obesity (body mass index ≥25 kg/m; HR = 1.91; 95% CI = 1.28, 2.84). CONCLUSIONS: Cumulative average PM2.5 exposure might increase the risk of HS. Elderly (≥65 years) and obese individuals may be more vulnerable to the effects of PM2.5 exposure.

Original languageEnglish
Pages (from-to)S90-S98
JournalEpidemiology (Cambridge, Mass.)
Volume30
DOIs
Publication statusPublished - 2019 Jul 1

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Stroke
National Health Programs
Confidence Intervals
Medical History Taking
Body Mass Index
Insurance
Proportional Hazards Models
Epidemiologic Studies
Cardiovascular Diseases
Retrospective Studies
Obesity
Smoking
Research Personnel
Databases

All Science Journal Classification (ASJC) codes

  • Epidemiology

Cite this

Noh, Juhwan ; Sohn, Jungwoo ; Han, Minkyung ; Kang, Dae Ryong ; Choi, Yoon Jung ; Kim, HyeonChang ; Suh, Il ; Kim, Changsoo ; Shin, Dong Chun. / Long-term Effects of Cumulative Average PM2.5 Exposure on the Risk of Hemorrhagic Stroke. In: Epidemiology (Cambridge, Mass.). 2019 ; Vol. 30. pp. S90-S98.
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title = "Long-term Effects of Cumulative Average PM2.5 Exposure on the Risk of Hemorrhagic Stroke",
abstract = "BACKGROUND: Epidemiological studies have revealed associations between the fine particle (PM2.5; aerodynamic diameter <2.5 μm) exposure and cardiovascular disease. Researchers have also recently begun investigating the association between PM2.5 exposure and hemorrhagic stroke (HS) and identifying subpopulations vulnerable to PM2.5 exposure. Long-term cumulative average PM2.5 exposure may affect the risk of HS, and these effects may be modified by risk factors. METHODS: This retrospective study evaluated the effects of PM2.5 on the time-to-first-diagnosis of HS among 62,676 Seoul metropolitan city residents with 670,431 total person-years of follow-up; this cohort is a subset from a nationally representative cohort of 1,025,340 individuals from the Korean National Health Insurance Service database (2002-2013). A time-dependent Cox proportional hazards model was used to adjust for age, sex, household income, insurance type, body mass index, smoking status, medical history, and family history. The annual mean PM2.5 concentrations for 25 districts were used as the time-dependent variable. Subgroup analyses of the traditional risk factors of HS were performed to evaluate potential effect modifications. RESULTS: Each 10-μg/m increment in cumulative average PM2.5 exposure was noticeably associated with HS (hazard ratio [HR] = 1.43; 95{\%} confidence interval [CI]: 1.09-1.88). The adverse effects of PM2.5 exposure were modified by ≥65 years of age (HR = 2.00; 95{\%} CI = 1.32, 3.02) and obesity (body mass index ≥25 kg/m; HR = 1.91; 95{\%} CI = 1.28, 2.84). CONCLUSIONS: Cumulative average PM2.5 exposure might increase the risk of HS. Elderly (≥65 years) and obese individuals may be more vulnerable to the effects of PM2.5 exposure.",
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Long-term Effects of Cumulative Average PM2.5 Exposure on the Risk of Hemorrhagic Stroke. / Noh, Juhwan; Sohn, Jungwoo; Han, Minkyung; Kang, Dae Ryong; Choi, Yoon Jung; Kim, HyeonChang; Suh, Il; Kim, Changsoo; Shin, Dong Chun.

In: Epidemiology (Cambridge, Mass.), Vol. 30, 01.07.2019, p. S90-S98.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-term Effects of Cumulative Average PM2.5 Exposure on the Risk of Hemorrhagic Stroke

AU - Noh, Juhwan

AU - Sohn, Jungwoo

AU - Han, Minkyung

AU - Kang, Dae Ryong

AU - Choi, Yoon Jung

AU - Kim, HyeonChang

AU - Suh, Il

AU - Kim, Changsoo

AU - Shin, Dong Chun

PY - 2019/7/1

Y1 - 2019/7/1

N2 - BACKGROUND: Epidemiological studies have revealed associations between the fine particle (PM2.5; aerodynamic diameter <2.5 μm) exposure and cardiovascular disease. Researchers have also recently begun investigating the association between PM2.5 exposure and hemorrhagic stroke (HS) and identifying subpopulations vulnerable to PM2.5 exposure. Long-term cumulative average PM2.5 exposure may affect the risk of HS, and these effects may be modified by risk factors. METHODS: This retrospective study evaluated the effects of PM2.5 on the time-to-first-diagnosis of HS among 62,676 Seoul metropolitan city residents with 670,431 total person-years of follow-up; this cohort is a subset from a nationally representative cohort of 1,025,340 individuals from the Korean National Health Insurance Service database (2002-2013). A time-dependent Cox proportional hazards model was used to adjust for age, sex, household income, insurance type, body mass index, smoking status, medical history, and family history. The annual mean PM2.5 concentrations for 25 districts were used as the time-dependent variable. Subgroup analyses of the traditional risk factors of HS were performed to evaluate potential effect modifications. RESULTS: Each 10-μg/m increment in cumulative average PM2.5 exposure was noticeably associated with HS (hazard ratio [HR] = 1.43; 95% confidence interval [CI]: 1.09-1.88). The adverse effects of PM2.5 exposure were modified by ≥65 years of age (HR = 2.00; 95% CI = 1.32, 3.02) and obesity (body mass index ≥25 kg/m; HR = 1.91; 95% CI = 1.28, 2.84). CONCLUSIONS: Cumulative average PM2.5 exposure might increase the risk of HS. Elderly (≥65 years) and obese individuals may be more vulnerable to the effects of PM2.5 exposure.

AB - BACKGROUND: Epidemiological studies have revealed associations between the fine particle (PM2.5; aerodynamic diameter <2.5 μm) exposure and cardiovascular disease. Researchers have also recently begun investigating the association between PM2.5 exposure and hemorrhagic stroke (HS) and identifying subpopulations vulnerable to PM2.5 exposure. Long-term cumulative average PM2.5 exposure may affect the risk of HS, and these effects may be modified by risk factors. METHODS: This retrospective study evaluated the effects of PM2.5 on the time-to-first-diagnosis of HS among 62,676 Seoul metropolitan city residents with 670,431 total person-years of follow-up; this cohort is a subset from a nationally representative cohort of 1,025,340 individuals from the Korean National Health Insurance Service database (2002-2013). A time-dependent Cox proportional hazards model was used to adjust for age, sex, household income, insurance type, body mass index, smoking status, medical history, and family history. The annual mean PM2.5 concentrations for 25 districts were used as the time-dependent variable. Subgroup analyses of the traditional risk factors of HS were performed to evaluate potential effect modifications. RESULTS: Each 10-μg/m increment in cumulative average PM2.5 exposure was noticeably associated with HS (hazard ratio [HR] = 1.43; 95% confidence interval [CI]: 1.09-1.88). The adverse effects of PM2.5 exposure were modified by ≥65 years of age (HR = 2.00; 95% CI = 1.32, 3.02) and obesity (body mass index ≥25 kg/m; HR = 1.91; 95% CI = 1.28, 2.84). CONCLUSIONS: Cumulative average PM2.5 exposure might increase the risk of HS. Elderly (≥65 years) and obese individuals may be more vulnerable to the effects of PM2.5 exposure.

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