Short-term Exposure to Outdoor Nitrogen Dioxide and Respiratory Mortality, with High-risk Populations: a Nationwide Time-stratified Case-crossover Study

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2024 Dec 19

PMID 39696118

Authors

Hyewon Yun

Seoyeong Ahn

Jieun Oh

Cinoo Kang

Ayoung Kim

Dohoon Kwon

Sojin Ahn

Jiwoo Park

Jinah Park

Ejin Kim

Ho Kim

Whanhee Lee

Affiliations

Soon will be listed here.

Abstract

Numerous existing studies reported the negative impacts of outdoor nitrogen dioxide (NO) on respiratory mortality. However, the evidence of related high-risk populations was considerably limited, especially associated with ages, causes of death, and district-level characteristics. In addition, most earlier studies were based on monitored areas, thus previous risk estimates of NO could be biased to provide nationwide risk estimates and high-risk populations. Therefore, this study performed a nationwide time-stratified case-crossover study to evaluate the association between short-term ambient NO and respiratory mortality in South Korea (2015-2019). A machine learning-ensemble daily NO prediction model was used to cover unmonitored areas. To examine high-risk populations, we assessed NO risk estimates by age group, sex, cause of mortality, and district-level characteristics. In the total population, NO was weakly associated with increased mortality risk due to respiratory disease (OR [odds ratio]: 1.011, 95% CI [confidence interval]: 0.995-1.027), and the association became evident only in individuals aged 80 y or older (1.022, 1.000-1.044), especially related to pneumonia. Further, in people aged 60-69 years, NO was marginally associated with mortality for chronic lower respiratory diseases. Lower district-level socioeconomic status and medical services were marginally related to higher respiratory mortality risks related to NO. The excess respiratory mortality fractions and YLL (year of life lost) attributable to NO were 4.13% and 93,851.63 years, and around 70% of the excess deaths were due to noncompliance with the World Health Organization air quality guidelines (daily average NO > 25 µg/m). This study provides evidence for high-risk populations and the appropriateness of target-specific action plans against NO. In addition, based on the excess death estimates, we suggest stricter NO standards are required.

References

Kim Y, Oh J, Kim S, Kim A, Park J, Ahn S . Relationship between short-term ozone exposure, cause-specific mortality, and high-risk populations: A nationwide, time-stratified, case-crossover study. Environ Res. 2024; 261:119712. DOI: 10.1016/j.envres.2024.119712. View

Kagawa J . Evaluation of biological significance of nitrogen oxides exposure. Tokai J Exp Clin Med. 1985; 10(4):348-53. View

Wang Z, Li Y, Lin J, Huang J, Zhang Q, Wang F . Prevalence, risk factors, and mortality of COPD in young people in the USA: results from a population-based retrospective cohort. BMJ Open Respir Res. 2023; 10(1). PMC: 10351298. DOI: 10.1136/bmjresp-2022-001550. View

Hesterberg T, Bunn W, McClellan R, Hamade A, Long C, Valberg P . Critical review of the human data on short-term nitrogen dioxide (NO2) exposures: evidence for NO2 no-effect levels. Crit Rev Toxicol. 2009; 39(9):743-81. DOI: 10.3109/10408440903294945. View

Levy D, Lumley T, Sheppard L, Kaufman J, Checkoway H . Referent selection in case-crossover analyses of acute health effects of air pollution. Epidemiology. 2001; 12(2):186-92. DOI: 10.1097/00001648-200103000-00010. View

Lee J, Kim H, Schwartz J . Bidirectional case-crossover studies of air pollution: bias from skewed and incomplete waves. Environ Health Perspect. 2001; 108(12):1107-11. PMC: 1240190. DOI: 10.1289/ehp.001081107. View

Lee Y, Oh J, Min K, Yong Lee S, Kang K, Shim J . The association between living below the relative poverty line and the prevalence of chronic obstructive pulmonary disease. J Thorac Dis. 2019; 11(2):427-437. PMC: 6409249. DOI: 10.21037/jtd.2019.01.40. View

Weyand C, Goronzy J . Aging of the Immune System. Mechanisms and Therapeutic Targets. Ann Am Thorac Soc. 2016; 13 Suppl 5:S422-S428. PMC: 5291468. DOI: 10.1513/AnnalsATS.201602-095AW. View

Di Q, Amini H, Shi L, Kloog I, Silvern R, Kelly J . Assessing NO Concentration and Model Uncertainty with High Spatiotemporal Resolution across the Contiguous United States Using Ensemble Model Averaging. Environ Sci Technol. 2019; 54(3):1372-1384. PMC: 7065654. DOI: 10.1021/acs.est.9b03358. View

10.

Wang M, Li H, Huang S, Qian Y, Steenland K, Xie Y . Short-term exposure to nitrogen dioxide and mortality: A systematic review and meta-analysis. Environ Res. 2021; 202:111766. PMC: 8578359. DOI: 10.1016/j.envres.2021.111766. View

11.

Becker S, Soukup J . Effect of nitrogen dioxide on respiratory viral infection in airway epithelial cells. Environ Res. 1999; 81(2):159-66. DOI: 10.1006/enrs.1999.3963. View

12.

Zeng W, Zhao H, Liu R, Yan W, Qiu Y, Yang F . Association between NO cumulative exposure and influenza prevalence in mountainous regions: A case study from southwest China. Environ Res. 2020; 189:109926. PMC: 7354378. DOI: 10.1016/j.envres.2020.109926. View

13.

Bell M, Dominici F, Samet J . A meta-analysis of time-series studies of ozone and mortality with comparison to the national morbidity, mortality, and air pollution study. Epidemiology. 2005; 16(4):436-45. PMC: 3581312. DOI: 10.1097/01.ede.0000165817.40152.85. View

14.

Chen R, Samoli E, Wong C, Huang W, Wang Z, Chen B . Associations between short-term exposure to nitrogen dioxide and mortality in 17 Chinese cities: the China Air Pollution and Health Effects Study (CAPES). Environ Int. 2012; 45:32-8. DOI: 10.1016/j.envint.2012.04.008. View

15.

Speizer F, Ferris Jr B, BISHOP Y, Spengler J . Respiratory disease rates and pulmonary function in children associated with NO2 exposure. Am Rev Respir Dis. 1980; 121(1):3-10. DOI: 10.1164/arrd.1980.121.1.3. View

16.

Mudway I, Kelly F . Ozone and the lung: a sensitive issue. Mol Aspects Med. 2000; 21(1-2):1-48. DOI: 10.1016/s0098-2997(00)00003-0. View

17.

Byun G, Kim S, Choi Y, Kim A, Team A, Lee J . Long-term exposure to PM and mortality in a national cohort in South Korea: effect modification by community deprivation, medical infrastructure, and greenness. BMC Public Health. 2024; 24(1):1266. PMC: 11080206. DOI: 10.1186/s12889-024-18752-y. View

18.

Samoli E, Aga E, Touloumi G, Nisiotis K, Forsberg B, Lefranc A . Short-term effects of nitrogen dioxide on mortality: an analysis within the APHEA project. Eur Respir J. 2006; 27(6):1129-38. DOI: 10.1183/09031936.06.00143905. View

19.

Meng X, Liu C, Chen R, Sera F, Vicedo-Cabrera A, Milojevic A . Short term associations of ambient nitrogen dioxide with daily total, cardiovascular, and respiratory mortality: multilocation analysis in 398 cities. BMJ. 2021; 372:n534. PMC: 7988454. DOI: 10.1136/bmj.n534. View

20.

Di Q, Wang Y, Zanobetti A, Wang Y, Koutrakis P, Choirat C . Air Pollution and Mortality in the Medicare Population. N Engl J Med. 2017; 376(26):2513-2522. PMC: 5766848. DOI: 10.1056/NEJMoa1702747. View