지역간 상대위험도 변동을 고려한 미세먼지 기인 질병부담 및 사회경제적 비용 추정 연구
Health and Economic Burden Attributable to Particulate Matter in South Korea: Considering Spatial Variation in Relative Risk
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background: Particulate matter (PM) is one of the leading causes of premature death worldwide. Previous studies in South Korea have applied a relative risk calculated from Western populations when estimating the disease burden attributable to PM. However, the relative risk of PM on health outcomes may not be the same across different countries or regions. Objectives: This study aimed to estimate the premature deaths and socioeconomic costs attributable to long- term exposure to PM in South Korea. We considered not only the difference in PM concentration between regions, but also the difference in relative risk. Methods: National monitoring data of PM concentrations was obtained, and missing values were imputed using the AERMOD model and linear regression model. As a surrogate for relative risk, hazard ratios (HRs) of PM for cardiovascular and respiratory mortality were estimated using the National Health Insurance Service- National Sample Cohort. The nation was divided into five areas (metropolitan, central, southern, south- eastern, and Gangwon-do Province regions). The number of PM attributable deaths in 2018 was calculated at the district level. The socioeconomic cost was derived by multiplying the number of deaths and the statistical value of life. Results: The average PM10 concentration for 2014~2018 was 45.2 μg/m3. The association between long-term exposure to PM10 and mortality was heterogeneous between areas. When applying area-specific HRs, 23,811 premature deaths from cardiovascular and respiratory disease in 2018 were attributable to PM10 (reference level 20 μg/m3). The corresponding socioeconomic cost was about 31 trillion won. These estimated values were higher than that when applying nationwide HRs. Conclusions: This study is the first research to estimate the premature mortality caused by long-term exposure to PM using relative risks derived from the national population. This study will help precisely identify the national and regional health burden attributed to PM and establish the priorities of air quality policy.
Abstract
Background: Particulate matter (PM) is one of the leading causes of premature death worldwide. Previous studies in South Korea have applied a relative risk calculated from Western populations when estimating the disease burden attributable to PM. However, the relative risk of PM on health outcomes may not be the same across different countries or regions. Objectives: This study aimed to estimate the premature deaths and socioeconomic costs attributable to long- term exposure to PM in South Korea. We considered not only the difference in PM concentration between regions, but also the difference in relative risk. Methods: National monitoring data of PM concentrations was obtained, and missing values were imputed using the AERMOD model and linear regression model. As a surrogate for relative risk, hazard ratios (HRs) of PM for cardiovascular and respiratory mortality were estimated using the National Health Insurance Service- National Sample Cohort. The nation was divided into five areas (metropolitan, central, southern, south- eastern, and Gangwon-do Province regions). The number of PM attributable deaths in 2018 was calculated at the district level. The socioeconomic cost was derived by multiplying the number of deaths and the statistical value of life. Results: The average PM10 concentration for 2014~2018 was 45.2 μg/m3. The association between long-term exposure to PM10 and mortality was heterogeneous between areas. When applying area-specific HRs, 23,811 premature deaths from cardiovascular and respiratory disease in 2018 were attributable to PM10 (reference level 20 μg/m3). The corresponding socioeconomic cost was about 31 trillion won. These estimated values were higher than that when applying nationwide HRs. Conclusions: This study is the first research to estimate the premature mortality caused by long-term exposure to PM using relative risks derived from the national population. This study will help precisely identify the national and regional health burden attributed to PM and establish the priorities of air quality policy.
참고문헌 (23)
- Pope CA 3rd, "Health effects of fine particulate air pollution : lines that connect", J Air Waste Manag Assoc, 56(6), pp.709~742 (2006)
- Rückerl R, "Health effects of particulate air pollution : a review of epidemiological evidence", Inhal Toxicol, 23(10), pp.555~592 (2011)
- 배현주, "서울시 미세먼지(PM10)와 초미세먼지(PM2.5)의 단기노출로 인한 사망영향", 한국환경보건학회지, 40(5), pp.346~354 (2014), 한국환경보건학회[DOI]
- 이형숙, "서울지역 미세먼지 농도가 호흡기계 및 심혈관계의 외래 방문 및 입원과 진료비에 미치는 영향", 한국환경보건학회지, 42(5), pp.324~332 (2016), 한국환경보건학회
- Cohen AJ, "Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution : an analysis of data from the Global Burden of Diseases Study 2015", Lancet, 389(10082), pp.1907~1918 (2017)
- 배현주, "초미세먼지의 심혈관계와 호흡기계 입원영향 평가 및 건강편익 산정", 응용경제, 18(3), pp.125~139 (2016), 한국응용경제학회
- 한창우, "Spatial and Temporal Trends of Number of Deaths Attributable to Ambient PM2.5 in the Korea", Journal of Korean Medical Science, 33(30), pp.1~14 (2018), 대한의학회
- 김종헌, "Premature Deaths Attributable to Long-term Exposure to Ambient Fine Particulate Matter in the Republic of Korea", Journal of Korean Medical Science, 33(37), pp.1~10 (2018), 대한의학회
- Krewski D, "Reanalysis of the Harvard Six Cities Study and the American Cancer Society Study of Particulate Air Pollution and Mortality" (2000), Health Effects Institute
- Burnett RT, "An integrated risk function for estimating the global burden of disease attributable to ambient fine particulate matter exposure", Environ Health Perspect, 122(4), pp.397~403 (2014)
- Turner MC, "Long-term ozone exposure and mortality in a large prospective study", Am J Respir Crit Care Med, 193(10), pp.1134~1142 (2016)
- Kim H, "Spatial variation in lag structure in the short-term effects of air pollution on mortality in seven major South Korean cities, 2006-2013", Environ Int, 125, pp.595~605 (2019)
- Kim S, "Interactions between ambient air particles and greenness on cause-specific mortality in seven Korean metropolitan cities, 2008-2016", Int J Environ Res Public Health, 16(10), pp.1866~ (2008)
- Zeka A, "Short term effects of particulate matter on cause specific mortality : effects of lags and modification by city characteristics", Occup Environ Med, 62(10), pp.718~725 (2005)
- Lee J, "Cohort profile : The National Health Insurance Service-National Sample Cohort(NHIS-NSC), South Korea", Int J Epidemiol, 46(2), pp.e15~ (2017)
- Samuelsen SO, "Attributable fractions with survival data", Stat Med, 27(9), pp.1447~1467 (2008)
- Kelly FJ, "Size, source and chemical composition as determinants of toxicity attributable to ambient particulate matter", Atmos Environ, 60, pp.504~526 (2012)
- Shin YC, "Establishment of Socio-Economic Analysis Foundation for Chemical Substances Management" (2017), National Institute of Environmental Research
- Chen J, "Long-term exposure to PM and all-cause and cause-specific mortality : a systematic review and meta-analysis", Environ Int, 143, pp.105974~ (2020)
- Kim H, "Effects of longterm exposure to air pollution on all-cause mortality and causespecific mortality in seven major cities of South Korea : Korean national health and nutritional examination surveys with mortality follow-up", Environ Res, 192, pp.110290~ (2021)
- 신영철, "질병예방행위 분석을 통한 확률적 인간생명가치 추정: 암 검진 행위 분석을 중심으로", 자원환경경제연구, 17(4), pp.845~874 (2008), 한국환경경제학회
- United States Environmental Protection Agency, "Guidelines for Preparing Economic Analyses", EPA, ~ (2010)
- Goldman GT, "Impact of exposure measurement error in air pollution epidemiology : effect of error type in time-series studies", Environ Health, 10, pp.61~ (2011)