Short-term Exposure to Air Pollution and Attributable Risk of Kidney Diseases

Abstract

Background: Several studies have shown that long-term exposure to air pollution is associated with reduced kidney function. However, less is known about effects of short-term exposure to air pollution on kidney disease aggravation and resultant emergency room (ER) burden. This study aimed to estimate excess ER visits attributable to short-term air pollution and to provide evidence relevant to air pollution standards to protect kidney patients. Methods: We conducted time-series analysis using National Health Insurance data covering all persons in South Korea (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013). We collected daily data for air pollutants (particulate matter ≤10 µm [PM 10 ], ozone [O 3 ], carbon monoxide [CO], and sulfur dioxide [SO 2 ]) and ER visits for total kidney and urinary system disease, acute kidney injury (AKI), and chronic kidney disease (CKD). We performed a two-stage time-series analysis to estimate excess ER visits attributable to air pollution by first calculating estimates for each of 16 regions, and then generating an overall estimate. Results: For all kidney and urinary disease (902,043 cases), excess ER visits attributable to air pollution existed for all pollutants studied. For AKI (76,330 cases), we estimated the highest impact on excess ER visits from O 3 , while for CKD (210,929 cases), the impacts of CO and SO 2 were the highest. The associations between air pollution and kidney ER visits existed for days with air pollution concentrations below current World Health Organization guidelines. Conclusion:This study provides quantitative estimates of ER burdens attributable to air pollution. Results are consistent with the hypothesis that stricter air quality standards benefit kidney patients.

Effects of short-term exposure to air pollution on hospital admissions for autism spectrum disorder in Korean school-aged children: a nationwide time-series study

“…Third, because this study was conducted in the Republic of Korea, a practically single-ethnic nation, caution should be exercised in generalising the results to other populations, given the potential heterogeneity of the results by race/ethnicity suggested by previous studies 43. Fourth, there is a concern of exposure misclassification attributable to large spatial units, although several time-series studies conducted in Korea used regional air pollution levels as exposures (instead of air pollution levels measured for a finer spatial unit) 44–46. This type of error (ie, Berkson error) is likely to lead to imprecision in the estimation of associations rather than bias.…”

“…43 Fourth, there is a concern of exposure misclassification attributable to large spatial units, although several time-series studies Open access conducted in Korea used regional air pollution levels as exposures (instead of air pollution levels measured for a finer spatial unit). [44][45][46] This type of error (ie, Berkson error) is likely to lead to imprecision in the estimation of associations rather than bias. Fifth, we only considered three criteria air pollutants (ie, PM 2.5 , NO 2 and O 3 ) as exposures according to previous studies.…”

Short-term air pollution exposure associated with death from kidney diseases: a nationwide time-stratified case-crossover study in China from 2015 to 2019

“…For example, a large time-stratified case-crossover study in the US Medicare population showed that each 10 µg/m 3 increase in PM 2.5 was associated with a 2.3% (95% CI: 1.7% to 3.0%) relative increase in the risk of acute and unspecified renal failure hospital admission [ 3 ]. Other time-series studies that investigated associations between short-term exposure to air pollution and emergency department visits for kidney diseases in North American and East Asian population reported relative percent changes ranging from 10% to 3.4% [ 1 , 2 ]. Another time-stratified case-crossover study in Hubei province of China estimated that each 10 µg/m 3 increase in PM 2.5 , PM 10 , and NO 2 was associated with a 4.14% (95% CI: 1.25% to 7.12%), 2.67% (95% CI: 0.80% to 4.57%), and 1.46% (95% CI: 0.76% to 2.17%) increase in odds of myocardial infarction mortality [ 17 ].…”

“…Epidemiological evidence has shown that both shortterm and long-term exposure to air pollution is associated with kidney outcomes [1][2][3][4][5][6][7]. A few time-series studies reported positive associations between shortterm exposure to air pollution and emergency department visits or hospitalizations for kidney diseases in North American and East Asian populations, and the risk ratios ranged from 1.010 to 1.034 [1][2][3].…”

“…Epidemiological evidence has shown that both shortterm and long-term exposure to air pollution is associated with kidney outcomes [1][2][3][4][5][6][7]. A few time-series studies reported positive associations between shortterm exposure to air pollution and emergency department visits or hospitalizations for kidney diseases in North American and East Asian populations, and the risk ratios ranged from 1.010 to 1.034 [1][2][3]. The associations of long-term exposure to air pollution with incident kidney diseases and kidney function decline were examined by several large national cohort studies from North America and China, and the magnitude of effect sizes was larger: the hazard ratios or odds ratios ranged from 1.07 to 1.39.…”