Long-term trends in mortality risks associated with short-term exposure to air pollution in 10 Japanese cities between 1977 and 2015
Hironori NishikawaXerxes SeposoLina MadaniyaziYoonhee KimAurelio Tobı́asMakiko YamagamiSatbyul Estella KimAkinori TakamiSeiji SugataYasushi HondaKayo UedaMasahiro HashizumeChris Fook Sheng Ng
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Background and aim: Short-term associations between air pollution and mortality have been well reported in Japan, but the historical changes of mortality risks remain unknown while Japan undergoes rapid aging. We examined temporal changes in the mortality risks associated with short-term exposure to four criteria air pollutants in selected Japanese cities. Methods: We collected daily mortality data for non-accidental causes (n=5,748,206), cardiovascular (n=1,938,743) and respiratory diseases (n=777,266), and air pollutants – SO₂, NO₂, suspended particulate matter (SPM) and oxidants (Ox) – of 10 cities from 1977 to 2015. We performed a two-stage analysis with 5-year stratification to estimate the relative risk (RR) of mortality per 10 unit increase in 2-day moving average of air pollutant concentrations. In the first stage, city-specific associations were assessed using a quasi-Poisson generalized linear regression model. In the second stage, the city-specific estimates were pooled using a random-effects meta-analysis. Ratio of relative risks (RRR) was computed to examine temporal changes. Results: Average concentrations in each stratified period decreased for SO₂, NO₂, and SPM (14.2–2.3 ppb, 29.4–17.5 ppb, 52.1–20.6 μg/m³, respectively) but increased for Ox (29.1–39.1 ppb), over the study period. When stratifying the analysis by every 5 years, the estimated risks of non-accidental mortality with these pollutants remained positive but did not show any clear trend. Meanwhile, the risk of respiratory mortality with SPM had increased (RRR of the latest period to that of the earliest period: 1.008, 95% CI: 1.002–1.015). The risks posed by these pollutants were slightly to moderately heterogeneous for the different cities. Conclusions: The respiratory mortality risk per 10 unit increase of SPM concentration was significantly higher in the latest period than in the earliest period. Other pollutant–mortality associations indicated either decrease or non-significant risk change in Japan between 1977 and 2015. Keywords: air pollution, daily mortality, time-varying effects, long-term trendA high concentration of air pollution can lead to health problems which are the cardiovascular and respiratory systems (WHO, 2014). A study has been conducted to know the relationship between five criteria air pollutants with hospitalization related to cardiovascular and respiratory diseases in two cities in Kelantan. The secondary data from 2000 until 2015 analyzed in the study were obtained from DOE and MOH for the air pollutants concentration and hospitalization, respectively. This study shows that the mean concentration of all pollutants in the study area is below the RMAAQS. Significant Relative Risk (RR) values were found for cardiovascular hospitalization associated with SO 2 (RR = 1.537, 95% CI = 2.970, 7.956), NO 2 (RR = 1.212, 95% CI = 1.156, 1.272), and O 3 (RR = 4.873, 95% CI = 2.768, 8.578). In contrast, significant RR for respiratory hospitalization was found to be associated with SO 2 (RR = 1.952, 95% CI = 1.013, 3.762), NO 2 (RR = 2.021, 95% CI = 6.170, 6.620), O 3 (RR = 1.128, 95% CI = 4.427, 2.874), and PM 10 (RR = 1.008, 95% CI = 1.007, 1.008). The highest value of Relative Risk is O 3 and NO 2 for hospitalization related to cardiovascular and respiratory diseases, respectively. In conclusion, the value of RR associated with air pollutants proves that air pollutants are associated with cardiovascular and respiratory-related hospitalization risk.
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서 론 역학 연구를 진행함에 있어 연구자가 연구를 타당하게 수행하기 위해서는 연구 계획단계에서 연구가설과 평가 변 수를 먼저 명확히 선정하는 것이 필요하다.또한 연구자가 수용 가능한 오류 안에서 연구 가설을 통계적으로 확증하 기 위해서는 필요한 대상수가 얼마인지 계산하는 대상수 산출의 과정을 거쳐야 한다.대상수 산출을 위해 필요한 정 보들은 통계 가설(귀무가설과 대립가설), 단측검정 혹은 양 측검정여부, 예상되는 효과 크기, 제 1종 오류와 제 2종 오 류가 기본적으로 필요하게 되며, 그 외에도 가설 증명에 적 절한 연구 설계, 연구 설계에 따른 적절한 통계분석 방법과 이에 따른 부수적인 값들이 필요하게 된다 [1,2].연구자가 연구 가설을 검정하기 위해 사용되는 통계적 가설 검정은 귀무가설과 대립가설을세우는 것에서부터 시 작한다.그 후 모아진 자료와 가설과의 일치성을 비교하거 나 각 가설에서 자료의 결과가 나왔을 확률을 계산하여 가 설 검정을 하게 된다.대립가설에 대해서만 일치도를 보게 되면 논증에서의 일반원칙인 엄밀성(general principle of parasimony)에 위배되게 된다 [2].따라서 대립가설뿐 아니 라 귀무가설에 대해서도 자료와의 일치성 정도를 같이 검 토하는 것이 필요하다.일치성을
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Abstract Sungshan, Longshan, Nankang and Mucha districts are selected for experimental research on particulate air pollution in Taipei. Air samples are taken from these districts and analyzed for total particulate weight, particle size distribution and chemical composition. The health status of students in some primary schools in these districts is also investigated. It is found that the particulate air pollution in Sungshan, Longshan and Nankang is serious. Lung function of the students in these three districts has been more or less damaged.
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I realize that all aspects of air pollution could not be covered in the report "Pediatric Aspects of Air Pollution" by the Committee on Environmental Hazards (Pediatrics, 46:637). The material presented suggests that there is an established clinical "cause and effect" relationship between air pollutants and disease; unfortunately this is not so. We have some statistics which indicate that air pollution affects patients with myocardial infarctions, and that mortality in the aged increased during air polution catastrophies (Meuse Valley, 1930; Donora, Pennsylvania, 1948; and London, 1952 and 1962).
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I realize that all aspects of air pollution could not be covered in the report Pediatric Aspects of Air Pollution by the Committee on Environmental Hazards (Pediatrics, 46:637). The material presented suggests that there is an established clinical cause and effect relationship between air pollutants and disease; unfortunately this is not so. We have some statistics which indicate that air pollution affects patients with myocardial infarctions, and that mortality in the aged increased during air polution catastrophies (Meuse Valley, 1930; Donora, Pennsylvania, 1948; and London, 1952 and 1962).
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To date, the assessment of public health consequences of air pollution has largely focused on a single-pollutant approach aimed at estimating the increased risk of adverse health outcomes associated with the exposure to a single air pollutant, adjusted for the exposure to other air pollutants. However, air masses always contain many pollutants in differing amounts, depending on the types of emission sources and atmospheric conditions. Because humans are simultaneously exposed to a complex mixture of air pollutants, many organizations have encouraged moving towards "a multipollutant approach to air quality." Although there is general agreement that multipollutant approaches are desirable, the challenges of implementing them are vast.
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