[논문]황사 및 관련예보 정확도가 천식질환 발생빈도에 미치는 상관관계 분석

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초록
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황사(Asian dust storm, ADS)란 중국이나 몽골 등 중앙아시아 지역의 사막 지대의 작은 모래나 황토 또는 먼지가 하늘에 떠다니다가 상층풍을 타고 멀리까지 날아가 떨어지는 현상을 말하며, 주로 봄철에 우리나라를 비롯한 동아시아 지역에 영향을 준다. 이와 같은 황사에 영향을 받는 지역에서는 거주민들의 건강에 부정적인 영향을 미치는 것으로 알려져 있다. 본 연구는 2005년도에서 2008년도까지 4년간 서울지역 거주민들 사이에서 황사현상이 천식질환에 미치는 영향을 분석하고자 한다. 이를 위해 황사발생일(기준일 또는 index day)과 기준일 대비 7일 전후(비교일 또는 comparison day) 황사가 발생하지 않은 날에 병의원에서 진료를 받은 천식환자 수를 황사예보의 정확도에 따라 비교 분석하였다. 그 결과 24시간 전 제공된 황사예보가 황사발생을 정확히 예측한 경우라 하더라도 비교일 대비 기준일의 천식환자 수가 여전히 더 많다는 사실을 알 수 있었다. 다만, 증가 정도는 통계적으로 유의한 수준은 아니었다는 점에서 정확한 황사예보가 최소한 어느 정도는 천식질환 발생을 저감시키는 효과는 분명히 가지고 있다고 판단할 수 있다. 반면에 24시간 전 황사예보가 황사발생을 정확하게 예측하지 못한 경우에는 비교일 대비 기준일에서 5~6일 후에 진료 받은 천식환자 수가 통계적으로 유의할 수준까지 높게 나타났다. 하지만, 기준일 및 기준일 다음 날의 경우에는 오히려 천식환자 수가 감소하는 경향을 보였다. 본 연구를 통해 황사예보 및 황사발생의 다양한 경우에 따라 천식환자 수의 일정한 변화패턴이 발견되었으며, 이와 같은 연구결과는 황사 관련 의료서비스 체계를 보다 효율적으로 설계하는데 활용될 수 있을 것으로 기대된다.

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문제 정의

Studies performed to date have analyzed the frequencies of diseases and deaths arising from the occurrence of ADS, but there have not been any studies analyzing the frequency of diseases caused by the accuracy of Asian dust forecasts. Thus, the purpose of this study is to analyze the effects of the accuracy of the ADS event forecast on the asthma attacks, a respiratory disease, in Seoul region from 2005 to 2008. For this purpose, the average numbers of medical treatments provided to asthma patients on the index days and the comparison days were compared.

제안 방법

For this purpose, the average numbers of medical treatments provided to asthma patients on the index days and the comparison days were compared. The comparative analysis was performed separately on the hit and miss cases, which were determined by whether the ADS forecast provided 24 hours in advance was correct (hit) or incorrect (miss).
Thus, a patient’s visit to the hospital itself may take place a few days after the ADS event. In order to reflect so-called the lag effect, this study adopted a moving average of the number of daily medical services for asthma patients from the ADS event day to the corresponding lag day in the paired t-test. For example, in order to observe the lag effect between the day of ADS occurrence and three days after the occurrence, a 4-day moving average of the number of visits to clinics on the index day, and the next three days as well as a 4-day moving average of the number of medical services on the comparison day and the next three days were used in the paired t-test for analysis.
In addition, the index days were categorized into two groups depending on whether the ADS forecast issued 24 hours in advance was correct (hit) or incorrect (miss) and a paired t-test was performed on each group to investigate the effects of the ADS forecasts on the frequency of asthma attacks. Also, in order to analyze the patterns of the number of medical services on the hit group and miss group in detail, each group was further divided into two groups according to the 24-hour average PM¹⁰ concentrations and t-tests were carried out on each of the four groups.
In addition, the index days were categorized into two groups depending on whether the ADS forecast issued 24 hours in advance was correct (hit) or incorrect (miss) and a paired t-test was performed on each group to investigate the effects of the ADS forecasts on the frequency of asthma attacks. Also, in order to analyze the patterns of the number of medical services on the hit group and miss group in detail, each group was further divided into two groups according to the 24-hour average PM¹⁰ concentrations and t-tests were carried out on each of the four groups.
In order to identify the different patterns of increase in the asthma cases between the miss group and the hit group, the groups was divided into sub-groups according to the concentration of Asian dust, i.e., the PM¹⁰ concentration, for analysis. Thus, the hit and miss groups were further divided into groups with PM¹⁰ concentration of less than 110μg/m³ and groups with PM¹⁰ concentration of over 110μg/m³ , and the average percentage increase in the number of medical services provided for asthma at each day lag of the index days compared to the comparison days was calculated for each group as shown in [Table 4].
The findings from the analysis of the total days of ADS occurrence from [Table 3] and [Figure 1] showed that there was a higher number of asthma patients on the index days than the comparison days and this number was statistically significant between the 4-day lag and 6-day lag, which indicates that the lag effect on the incidence of asthma occurs from 4-day lag and onwards. The effects of ADS on asthma were categorized for analysis depending on the accuracy of the ADS forecast provided 24 hours prior to the actual ADS event day in order to identify the impact of the ADS forecast. For this purpose, the patterns of the p-values were obtained from the paired t-tests for the hit group and miss group according to the day lags shown in [Figure 1], and a comparison showed in the case of hit group, the numbers of asthma patients on the index days was higher than those on the comparison days but it was not statistically significant for all day lags.

데이터처리

We performed paired t-tests on the numbers of asthma patients on the index days and comparison days. If ADS occurred on one of the two comparison days, only the number of medical services provided on the other comparison day was used as data for the paired t-test. If ADS occurred on both comparison days of an index day, they were excluded from the analysis data.
In order to reflect so-called the lag effect, this study adopted a moving average of the number of daily medical services for asthma patients from the ADS event day to the corresponding lag day in the paired t-test. For example, in order to observe the lag effect between the day of ADS occurrence and three days after the occurrence, a 4-day moving average of the number of visits to clinics on the index day, and the next three days as well as a 4-day moving average of the number of medical services on the comparison day and the next three days were used in the paired t-test for analysis.

이론/모형

This study employs the concept of index days and comparison days used by [2, 16]. Index days are defined as the corresponding days on which windblown ADS events are actually occurred.

성능/효과

Thus, the hit and miss groups were further divided into groups with PM10 concentration of less than 110μg/m3 and groups with PM10 concentration of over 110μg/m3 , and the average percentage increase in the number of medical services provided for asthma at each day lag of the index days compared to the comparison days was calculated for each group as shown in [Table 4].

참고문헌 (16)

Bateson, T. F. and Schwartz, J.; "Control for seasonal variation and time trend in case-crossover studies of acute effects of environmental exposures," Epidemiology, 10 : 539-544, 1999.

상세보기
Chen, Y. S., Sheen, P. C., Chen, E. R., Liu, Y. K., Wu, T. N., and Yang, C. Y.; "Effects of Asian dust storm events on daily mortality in Taipei, Taiwan," Environmental Research, 95 : 151-155, 2004.

상세보기
Chun, Y. S., Cho, H. K., Chung, H. S., and Lee, M. H.; "Historical records of Asian dust events (Hwangsa) in Korea," Bulletin of the American Meteorological Society, 89(6) : 823-827, 2008.

상세보기
Donaldson, K. and MacNee, W.; "The mechanism of lung injury caused by PM10," Issues in Environmental Science and Technology, Hester, R. E. and Harrison, R. M. (Ed.), The Royal Society of Chemistry, London, 1998.
Hong, Y. C., Pan, X. C., Kim, S. Y., Park, K., Park, E. J., Jin, X., Yi, S. M., Kim, Y. H., Park, C. H., Song, S., and Kim, H.; "Asian dust storm and pulmonary function of school children in Seoul," Science of the Total Environment, 408 : 754-759, 2010.

상세보기
Husar, R. B., Tratt, D. B., Schichtel, B. A., Falke, S. R., Li, F., Jaffe, D., Gasso, S., Gillt, T., and Laulainen, N. S.; "Asian dust events of April 1998," Journal of Geophysical Research, 106 : 18316-18330, 2001.
Hwang, S. S., Cho, S. H., Kang, D., Kim, H., Ha, E. H., and Kwon, H. J.; "The Asian dust events and hospital admissions with respiratory and cardiovascular disease in Seoul, Korea," Epidemilology, 14(Suppl5) : 199-201, 2003.
Korea Meteorological Administration (KMA); Annual Climatological Report, 2010.
Kwon, H. J., Cho, S. H., Chun, Y., Lagarde, F., and Pershagen, G.; "Effects of the Asian dust events on daily mortality in Seoul, Korea," Environmental Research, 90 : 1-5, 2002.

상세보기
Lee, B. K. and Jeong, E. R.; "Analysis of indoor and outdoor characteristics of PM10 during Asian dust events in Korea," Proceedings of the Korean Environmental Sciences Society Conference, 19-20, 2006.
Lee, J. T., Son, J. Y., and Cho, Y. S.; "A comparison of mortality related to urban air particles between periods with Asian dust days and without Asian dust days in Seoul, Korea, 2000-2004," Environmental Research, 105 : 409-413, 2007.

상세보기
Lei, Y. C., Chan, C. C., Wang, P. Y., Lee, C. T., and Cheng, T. J.; "Effects of Asian dust event particles on inflammation markers in peripheral blood and bronchoalveolar lavage in pulmonary hypertensive rats," Environmental Research, 95 : 71-76, 2004.

상세보기
McKendry, I. G., Hacker, J. P., Stull, R., Sakiyama, S., Mignacca, D., and Reid, K.; "Long-range transport of Asian dust to the Lower Fraser Valley, British Columbia, Canada," Journal of Geophysical Research, 106 : 18361-18370, 2001.

상세보기
Meng, Z. and Lu, B.; "Dust events as a risk factor for daily hospitalization for respiratory and cardiovascular diseases in Minqin, China," Atmospheric Environment, 41 : 7048-7058, 2007.

상세보기
Park, J. W., Lim, Y. H., Kyung, S. Y. An, C. H., Lee, S. P., Jeong, S. H., and Ju, Y. S.; "Effects of ambient particulate matter on peak expiratory flow rates and respiratory symptoms of asthmatics during Asian dust periods in Korea," Respirology, 10 : 470-476, 2005.

상세보기
Yang, C. Y., Chen, Y. S., Chiu, H. F., and Goggins, W. B.; "Effects of Asian dust storm events on daily stroke admissions in Taipei, Taiwan," Environmental Research, 99 : 79-84, 2005.

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[국내논문] 황사 및 관련예보 정확도가 천식질환 발생빈도에 미치는 상관관계 분석
Correlation Analysis About the Effect of Asian Dust Storm and Related Forecasts on Asthma Disease 원문보기

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[국내논문] 황사 및 관련예보 정확도가 천식질환 발생빈도에 미치는 상관관계 분석 Correlation Analysis About the Effect of Asian Dust Storm and Related Forecasts on Asthma Disease 원문보기

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[국내논문] 황사 및 관련예보 정확도가 천식질환 발생빈도에 미치는 상관관계 분석
Correlation Analysis About the Effect of Asian Dust Storm and Related Forecasts on Asthma Disease 원문보기

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