[논문]<tex>$PM_{10}$</tex> Exposure and Non-accidental Mortality in Asian Populations: A Meta-analysis of Time-series and Case-crossover Studies

Park, Hye Yin; Bae, Sanghyuk; Hong, Yun-Chul

doi:10.3961/jpmph.2013.46.1.10

$PM_{10}$ Exposure and Non-accidental Mortality in Asian Populations: A Meta-analysis of Time-series and Case-crossover Studies 원문보기

Journal of preventive medicine and public health = 예방의학회지, v.46 no.1, 2013년, pp.10 - 18

Park, Hye Yin (Department of Preventive Medicine, Seoul National University College of Medicine) , Bae, Sanghyuk (Department of Preventive Medicine, Seoul National University College of Medicine) , Hong, Yun-Chul (Department of Preventive Medicine, Seoul National University College of Medicine)

Abstract ▼ AI-Helper

Objectives: We investigated the association between particulate matter less than $10{\mu}m$ in aerodynamic diameter ($PM_{10}$) exposure and non-accidental mortality in Asian populations by meta-analysis, using both time-series and case-crossover analysis. Methods: Among the 819 published studies searched from PubMed and EMBASE using key words related to $PM_{10}$ exposure and non-accidental mortality in Asian countries, 8 time-series and 4 case-crossover studies were selected for meta-analysis after exclusion by selection criteria. We obtained the relative risk (RR) and 95% confidence intervals (CI) of non-accidental mortality per $10{\mu}g/m^3$ increase of daily $PM_{10}$ from each study. We used Q statistics to test the heterogeneity of the results among the different studies and evaluated for publication bias using Begg funnel plot and Egger test. Results: Testing for heterogeneity showed significance (p<0.001); thus, we applied a random-effects model. RR (95% CI) per $10{\mu}g/m^3$ increase of daily $PM_{10}$ for both the time-series and case-crossover studies combined, time-series studies relative risk only, and case-crossover studies only, were 1.0047 (1.0033 to 1.0062), 1.0057 (1.0029 to 1.0086), and 1.0027 (1.0010 to 1.0043), respectively. The non-significant Egger test suggested that this analysis was not likely to have a publication bias. Conclusions: We found a significant positive association between $PM_{10}$ exposure and non-accidental mortality among Asian populations. Continued investigations are encouraged to contribute to the health impact assessment and public health management of air pollution in Asian countries.

주제어

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제안 방법

In conclusion, we found a significant positive association between PM₁₀ exposure and non-accidental mortality among Asian populations, and this association was confirmed in meta-analyses of time-series studies, case-crossover studies, and both study designs combined. We encourage further investigations to contribute to the health impact assessment and public health management of air pollution in Asian countries.
Literature searches were conducted using a combination of three groups of keywords: Asian country names (Korea, Japan, China, Mongolia, Thailand, Malaysia, Indonesia, Vietnam, Papua New Guinea, Philippines, Singapore, and Taiwan); PM₁₀, as exposure; and non-accidental mortality, as outcome. Thus, using PubMed, EMBASE, and the Cochran Library, the searched keywords were [Korea OR Japan OR China OR Mongolia OR Thailand OR Malaysia OR Indonesia OR “Vietnam” OR “Papua New Guinea” OR Philippines OR Singapore OR Taiwan AND (PM₁₀ OR “air pollution” OR particulate) AND mortality].
The results from each study varied in population size, mean PM₁₀concentrations, and daily mortality count, and therefore the size estimate. Low levels of daily PM₁₀levels were reported in Hong Kong and Bangkok (51.
42) as the random-effect [27]. This study is similar to our study with some overlapping studies, but it is limited to time-series designs only, while our study also includes a case-crossover analysis. We have also used more recent studies for Seoul and Bangkok and have included study results from the novel regions, Tianjin and Guangzhou.
Thus, in this study, we attempt to investigate the association between PM₁₀ exposure and non-accidental mortality in Asian countries by including both designs in searching the literature.

이론/모형

We chose a fixed effects model on observing the homogeneity among the studies, and a random effects model on observing the heterogeneity. Evaluation for publication bias was performed using Begg funnel plot and Egger test. For both tests for heterogeneity and publication bias, longitude and latitude information were used as modifiers.

성능/효과

In our results, a higher effect size was estimated from the time-series studies than the case-crossover studies, and the results were statistically significant in both groups. Due to the low number of studies used in the meta-analysis, our findings may not be the definitive supplement to comparisons of the two study designs.

후속연구

First, we excluded results with adjustments for co-pollutants from the selected studies, due to a lack of, or different combinations of co-pollutants. As the combined effect of pollutants may be different in magnitude from the effect of PM₁₀ alone and we cannot ignore possible interaction, further investigation is recommended with more research on co-pollutant effects over time. Also, we did not analyze for cardiovascular and respiratory mortality in our analysis, although many researchers have focused on the two outcomes.
Authors have proposed that these systemic reactions may extend to non-accidental mortality, including cardiovascular and respiratory mortality. Nonetheless, further research is needed to elucidate the exact pathological mechanism linking PM10 exposure to mortality.

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