Association between heat and hospital admissions in people with disabilities in South Korea: a nationwide, case-crossover study.

BACKGROUND: Despite extensive findings on the hazardous impacts of environmental heat exposure, little is known about the effect on people with disabilities. This study aimed to estimate the association between environmental heat exposure and emergency department admissions for people with disabilities compared with people without disabilities. METHODS: In this nationwide, case-crossover study, we linked data on emergency department admissions (cases) for any cause in the warm season in South Korea from the Korean National Health Insurance Service (NHIS)-National Sample Cohort database (a nationally representative database of 1 million systematically sampled beneficiaries covering all ages) from Jan 1, 2002, to Dec 31, 2019, and short-term daily mean temperature exposure (measured via Google Earth Engine at a 9 km spatial grid, aggregated to district). We defined beneficiaries with disabilities as those who were registered as disabled in the NHIS; disabilities included in our study were physical disability, brain lesion disorders, blindness or vision loss, and deafness or hearing loss. Other types of disability were not included for confidentiality reasons. A time-stratified case-crossover design, in which participants served as their own control, was used with conditional logistic regression to estimate the association between heat and emergency department admissions in people with and without disabilities. FINDINGS: 23 792 emergency department admissions were recorded for 59 527 people with disabilities. Of these 23 792 admissions, 10 234 (43·0%) individuals were female and 13 558 (57·0%) were male. The odds ratio (OR) of emergency department admissions associated with heat (99th temperature percentile vs 75th percentile) was 1·15 (95% CI 1·07-1·24) in people with disabilities and 1·06 (1·04-1·09) in people without disabilities. The annual excess number of emergency department admissions attributable to heat per 100 000 persons-years was 27·81 admissions (95% CI 9·20-45·69) and excess medical costs were US$638 739·47 (95% CI 201 900·12-1 059 641·87) in people with disabilities; these values were more than four times that of the non-disabled population. People with brain lesion disorders, people with severe physical disabilities, female individuals, and those aged 65 years or older showed higher heat risks. The risks of emergency department admissions due to mental disorder (1·89, 95% CI 1·18-3·00) and respiratory diseases (1·34, 1·06-1·70) also showed higher heat risks than for the other two analysed causes of admission (cardiovascular and genitourinary diseases). INTERPRETATION: Heat was associated with increased risk of emergency department admissions for people with and without disabilities, but the risk appeared to be higher for those with disabilities. These results can inform policy makers when establishing action plans for people with disabilities. FUNDING: National Research Foundation of Korea, the South Korean Ministry of Environment, and the South Korean Ministry of Education.

Heat and hospital admission via the emergency department for people with intellectual disability, autism, and mental disorders in South Korea: a nationwide, time-stratified, case-crossover study.

BACKGROUND: Given the anticipated increase in ambient temperature due to climate change, the hazardous effects of heat on health have been extensively studied; however, its impact on people with intellectual disability, autism, and mental illness is largely unknown. We aimed to estimate the association between heat and hospitalisation through the emergency department (ED) among people with these mental disorders. METHODS: In this nationwide study, we used data from the National Health Insurance Database (NHID) of the National Health Insurance Service, the single universal insurer in South Korea, the claims data for which is based on the ICD-10. We included individuals with identified intellectual disability, autism, and mental disorders (including schizophrenia, bipolar disorder, recurrent depressive disorder, schizoaffective disorder and persistent obsessive-compulsive disorder, Tourette's disorder, and narcolepsy) and we established two control groups of people without these disorders: one including 1 million systematically sampled individuals, and one matched to the cohort based on sex, age, and income group. Data on hospital admission via the ED were obtained from the NHID, including the primary cause of admission and corresponding medical costs, for the warm season (June-September) of the period 2006-2021. We used the Google Earth Engine with the ERA5-Land dataset to collect data on the daily mean temperature. We applied a time-stratified case-crossover design using a distributed lag non-linear model and performed a conditional logistic regression. The risk ratio was estimated as the odds ratio (OR) with calculated odds at the 99th percentile temperature compared with that at the local 75th percentile temperature. We did not include people with lived experience of mental illness in this study. FINDINGS: Of the 456 946 people with intellectual disability, autism, or mental disorder in the NHID records, 99 845 were admitted to the ED, including 59 821 (59·9%) males and 40 024 (40·1%) females, and including 29 192 people with intellectual disability, 1428 people with autism, and 69 225 people with mental disorders. We were not able to collect data on ethnicity. The mean age at ED admission was 42·1 years (SD 17·9, range 0-102) for people with intellectual disability, 18·6 years (SD 10·4, range 1-72) for people with autism, and 50·8 years (SD 11·9, range 2-94) for people with mental disorders. The heat OR (odds at the 99th percentile vs 75th percentile of temperature) of ED admission was 1·23 (95% CI 1·11-1·36) for intellectual disability, 1·06 (0·68-1·63) for autism, and 1·20 (1·12-1·29) for mental disorders. People with intellectual disability, female individuals, people living in rural areas, or those with a low-income status were at increased risk of ED admission due to heat. The risk of ED admission due to genitourinary diseases was higher than that from other causes. Annual increase in medical costs attributable to heat among people with intellectual disability, autism, and mental disorders was US$ 224 970 per 100 000 person-years (95% empirical CI 139 784-305 770). INTERPRETATION: People with intellectual disability, autism, and mental disorders should be included in groups considered at a high-risk for heat exposure, and heat adaptation policies should be implemented with consideration of these groups and their needs. FUNDING: The National Research Foundation of Korea, Korean Ministry of Environment, and Korean Ministry of Education. TRANSLATION: For the Korean translation of the abstract see Supplementary Materials section.

Interrupting Effect of Social Distancing on Ischemic Heart Disease, Asthma, Stroke, and Suicide Attempt Patients by PM2.5 Exposure.

PURPOSE: This study aimed to examine the interrupting effect of social distancing (SD) on emergency department (ED) patients with ischemic heart disease (IHD), stroke, asthma, and suicide attempts by PM2.5 exposure in eight Korean megacities from 2017 to 2020. MATERIALS AND METHODS: The study used National Emergency Department Information System and AirKorea data. A total of 469014 patients visited EDs from 2017 to 2020. Interrupted time series analysis was employed to examine changes in the level and slope of the time series, relative risk, and confidence intervals (CIs) by PM2.5 exposure. The SD level was added to the sensitivity analysis. RESULTS: The interrupted time series analysis demonstrated a significant increase in the ratio of relative risk (RRR) of IHD patients in Seoul (RRR=1.004, 95% CI: 1.001, 1.006) and Busan (RRR=1.007, 95% CI: 1.002, 1.012) post-SD. Regarding stroke, only patients in Seoul exhibited a significant decrease post-SD (RRR=0.995, 95% CI: 0.991, 0.999). No significant changes were observed for asthma in any of the cities. In the case of suicide attempts, Ulsan demonstrated substantial pre-SD (RR=0.827, 95% CI: 0.732, 0.935) and post-SD (RRR=1.200, 95% CI: 1.057, 1.362) differences. CONCLUSION: While the interrupting effect of SD was not as pronounced as anticipated, this study did validate the effectiveness of SD in modifying health behaviors and minimizing avoidable visits to EDs in addition to curtailing the occurrence of infectious diseases.

The estimated mediating roles of anemia-related variables in the association between kidney function and mortality: a National Health and Nutrition Examination Survey (NHANES) study.

Anemia is a common complication of chronic kidney disease (CKD), impacting long-term outcomes such as mortality and morbidity. Analyzing NHANES data from 1999 through 2016 for adults aged ≥ 20 years, we assessed the mediating effects of anemia biomarkers (hemoglobin, hematocrit, red cell distribution width [RDW], and mean corpuscular hemoglobin concentration [MCHC]) on CKD-related outcomes by using hazard ratios from a biomarker-adjusted model. Of 44,099 participants, 7463 experienced all-cause death. Cox proportional hazard models revealed a higher all-cause mortality risk in the > 45 years and CKD groups than in the early CKD group. Hemoglobin, hematocrit and MCHC were inversely related to all-cause mortality; RDW was related to mortality. Single mediation analysis showed greater mediating effects of anemia indicators on CKD and mortality in the elderly (> 65 years) population than those in the general population. In the multimediation analysis, the combined mediating effect of anemia was higher in the CKD population than in the general population. This study showed a proportional increase in the mediating effect of anemia with CKD stage, suggesting potential therapeutic avenues. However, further exploration of other mediating factors on kidney outcomes is necessary.

Timely accessibility to healthcare resources and heatwave-related mortality in 7 major cities of South Korea: a two-stage approach with principal component analysis.

Background: Due to the ongoing effects of climate change, the incidence of heatwave-related mortality is rising globally. Improved allocation and utilization of healthcare resources could help alleviate this issue. This study aimed to identify healthcare resource factors associated with heatwave-related mortality in seven major cities of South Korea. Methods: We analyzed daily time-series data on mean temperature and all-cause mortality from 2011 to 2019. Using principal component analysis (PCA), we clustered district-level healthcare resource indicators into three principal components (PCs). To estimate district-specific heatwave-mortality risk, we used a distributed lag model with a quasi-Poisson distribution. Furthermore, a meta-regression was performed to examine the association between healthcare resources and heatwave-mortality risk. Findings: A total of 310,363 deaths were analyzed in 74 districts. The lag-cumulative heatwave-related mortality (RRs) ranged from 1.12 (95% confidence interval [CI]: 1.07, 1.17) to 1.21 (95% CI 1.05, 1.38), depending on the definitions used for heatwaves. Of the three PCs for healthcare resources (PC1: pre-hospital emergency medical service, PC2: hospital resources, PC3: timely access), timely access was associated with reduced risk of heatwave-related mortality, particularly among the elderly. Specifically, timely access to any emergency room (ER) exhibited the strongest association with lower heatwave-related mortality. Interpretation: Our findings suggest that timely access to any ER is more effective in reducing heatwave-related mortality risk than access to higher-level healthcare facilities, especially among the elderly. Therefore, healthcare resource factors and ER accessibility should be prioritized when identifying vulnerable populations for heatwaves, along with known individual and socio-demographic factors. Funding: This work was supported by the Research Program funded by the Korea Disease Control and Prevention Agency (2022-12-303), the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. 2022R1A2C2092353) and the MD-PhD/Medical Scientist Training Program through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea.

Disparities in the association between ambient temperature and preterm birth according to individual and regional characteristics: a nationwide time-stratified case-crossover study.

BACKGROUND: Several studies have reported that climate change elevates heat exposure in pregnant women and high temperatures during pregnancy are associated with preterm births (PTBs). Although the association might be disproportionate, related evidence remains sparse. We evaluated the disproportionate risk of PTB associated with ambient temperature during pregnancy by individual and regional characteristics in South Korea. METHODS: We collected data on birth certificates and daily mean temperatures during the period from 2011 to 2019. A time-stratified case-crossover design was used to investigate the association between temperature and PTB and stratified analyses were conducted to examine the effect modification of individual and regional characteristics. RESULTS: A total of 160,067 singleton PTBs were recorded in Korea from 2011 to 2019. A 5℃ increase in the mean temperature during the last four weeks before delivery was associated with an increased risk of PTB with an odds ratio (OR) of 1.03 (95% confidence interval [CI]: 1.02, 1.05), and the association was more evident in mothers aged ≥35 years (OR: 1.06 [95% CI: 1.03, 1.10]) and with low education levels (OR: 1.04 [95% CI: 1.02, 1.05]). Additionally, the estimated risk was evident in districts with lower medical resources and more prominent disparities were shown by individual and regional characteristics in rural areas than in urban areas. CONCLUSIONS: This study provides evidence that the risk of PTB related to ambient temperature is disproportionate by individual and regional characteristics and suggests the need for public health policies to alleviate the disparities, especially in rural areas.

Ozone-related acute excess mortality projected to increase in the absence of climate and air quality controls consistent with the Paris Agreement.

Short-term exposure to ground-level ozone in cities is associated with increased mortality and is expected to worsen with climate and emission changes. However, no study has yet comprehensively assessed future ozone-related acute mortality across diverse geographic areas, various climate scenarios, and using CMIP6 multi-model ensembles, limiting our knowledge on future changes in global ozone-related acute mortality and our ability to design targeted health policies. Here, we combine CMIP6 simulations and epidemiological data from 406 cities in 20 countries or regions. We find that ozone-related deaths in 406 cities will increase by 45 to 6,200 deaths/year between 2010 and 2014 and between 2050 and 2054, with attributable fractions increasing in all climate scenarios (from 0.17% to 0.22% total deaths), except the single scenario consistent with the Paris Climate Agreement (declines from 0.17% to 0.15% total deaths). These findings stress the need for more stringent air quality regulations, as current standards in many countries are inadequate.

Long-term exposure to high perceived temperature and risk of mortality among patients with chronic kidney disease.

Health risks due to climate change are emerging, particularly from high-temperature exposure. The perceived temperature is an equivalent temperature based on the complete heat budget model of the human body. Therefore, we aimed to analyze the effect of perceived temperature on overall mortality among patients with chronic kidney disease. In total, 32,870 patients with chronic kidney disease in Seoul participated in this retrospective study (2001-2018) at three medical centers. The perceived temperature during the summer season was calculated using meteorological factors, including the air temperature near the automated weather station, dew point temperature, wind velocity, and total cloud amount. We assessed the association between perceived temperature using Kriging spatial interpolation and mortality in patients with CKD in the time-varying Cox proportional hazards model that was adjusted for sex, age, body mass index, hypertension, diabetes mellitus, estimated glomerular filtration rate, smoking, alcohol consumption, and educational level. During the 6.14 ± 3.96 years of follow-up, 3863 deaths were recorded. In multivariable analysis, the average level of perceived temperature and maximum level of perceived temperature demonstrated an increased risk of overall mortality among patients with chronic kidney disease. The concordance index for mortality of perceived temperature was higher than temperature, discomfort index, and heat index. When stratified by age, diabetes mellitus, and estimated glomerular filtration rate, patients with chronic kidney disease with young age (age <65 years) showed higher hazard ratio for mortality (interaction P = 0.049). Moreover, the risk of death in the winter and spring seasons was more significant compared to that of the summer and autumn seasons. Therefore, long-term exposure to high perceived temperature during summer increases the risk of mortality among patients with chronic kidney disease.

Association between long-term PM2.5 exposure and risk of Kawasaki disease in children: A nationwide longitudinal cohort study.

BACKGROUND: Based on previous studies suggesting air pollution as a potential risk factor for Kawasaki Disease (KD), we examined the association of long-term exposure to childhood fine particulate matter (PM2.5) with the risk of KD. METHODS: We used National Health Insurance Service-National Sample Cohort data from 2002 to 2019, which included beneficiaries aged 0 years at enrollment and followed-up until the onset of KD or age 5 years. The onset of KD was defined as the first hospital visit record with a primary diagnostic code of M30.3, based on the 10th revision of the International Classification of Diseases, and with an intravenous immunoglobulin (IVIG) prescription. We assigned PM2.5 concentrations to 226 districts, based on mean annual predictions from a machine learning-based ensemble prediction model. We performed Cox proportional-hazards modeling with time-varying exposures and confounders. RESULTS: We identified 134,634 individuals aged five or less at enrollment and, of these, 1220 individuals who had a KD onset and an IVIG prescription during study period. The average annual concentration of PM2.5 exposed to the entire cohort was 28.2 µg/m³ (Standard Deviation 2.9). For each 5 µg/m³ increase in annual PM2.5 concentration, the hazard ratio of KD was 1.21 (95% CI 1.05-1.39). CONCLUSIONS: In this nationwide, population-based, cohort study, long-term childhood exposure to PM2.5 was associated with an increased incidence of KD in children. The study highlights plausible mechanisms for the association between PM2.5 and KD, but further studies are needed to confirm our findings.

Fluctuating risk of acute kidney injury-related mortality for four weeks after exposure to air pollution: A multi-country time-series study in 6 countries.

BACKGROUND: Recent studies have reported that air pollution is related to kidney diseases. However, the global evidence on the risk of death from acute kidney injury (AKI) owing to air pollution is limited. Therefore, we investigated the association between short-term exposure to air pollution-particulate matter ≤ 2.5 µm (PM2.5), ozone (O3), and nitrogen dioxide (NO2)-and AKI-related mortality using a multi-country dataset. METHODS: This study included 41,379 AKI-related deaths in 136 locations in six countries during 1987-2018. A novel case time-series design was applied to each air pollutant during 0-28 lag days to estimate the association between air pollution and AKI-related deaths. Moreover, we calculated AKI deaths attributable to non-compliance with the World Health Organization (WHO) air quality guidelines. RESULTS: The relative risks (95% confidence interval) of AKI-related deaths are 1.052 (1.003, 1.103), 1.022 (0.994, 1.050), and 1.022 (0.982, 1.063) for 5, 10, and 10 µg/m3 increase in lag 0-28 days of PM2.5, warm-season O3, and NO2, respectively. The lag-distributed association showed that the risk appeared immediately on the day of exposure to air pollution, gradually decreased, and then increased again reaching the peak approximately 20 days after exposure to PM2.5 and O3. We also found that 1.9%, 6.3%, and 5.2% of AKI deaths were attributed to PM2.5, warm-season O3, and NO2 concentrations above the WHO guidelines. CONCLUSIONS: This study provides evidence that public health policies to reduce air pollution may alleviate the burden of death from AKI and suggests the need to investigate the several pathways between air pollution and AKI death.

Greenness and kidney? A review of epidemiological studies on the association between green space and kidney disease.

Recent accumulating epidemiological evidence underlines the important role of environmental exposures on kidney diseases. Among environmental exposures, this study addresses "Green space," which has been recognized as one of the major environmental exposures at the population level. We review a total of seven epidemiological studies currently published on greenness and kidney disease. We also discuss knowledge gaps in the epidemiological evidence in relation to study design, greenness exposure index, emerging kidney outcomes, and inequalities. With an increase in public attention regarding environmental risks and climate change, an improved understanding of the beneficial effects of green space can play an important role in promoting kidney health.

Beneficial impacts of residential greenness on sleep deprivation in adults aged 19 or older living in South Korea: A nationwide community health survey in 2011-2018.

BACKGROUND: Evidence of the relationship between greenness and sleep is limited, and, given the worsening sleep insufficiency worldwide, this relationship needs elucidation. In this study, we investigated the association of greenness with sleep deprivation using nationwide survey data. METHODS: This study included 1,727,273 participants in the Korea Community Health Survey who resided in all 229 districts of South Korea from 2011 to 2018. Sleep deprivation variables were defined as strong deprivation or mild deprivation, based on average daily sleep duration of <5 or 5-6 h, respectively. District-specific annual average of satellite-derived enhanced vegetation index (EVI) was used as a green space exposure. A logistic regression with complex survey weights was used to estimate the association between greenness and sleep deprivation, and it was further examined by sex, age group, educational status, income level, and population density. The regression analysis was performed annually, and the annual estimates were pooled by a combined data analysis. RESULTS: A higher level of greenness was associated (odds ratio [95 % confidence interval]) with strong and mild sleep deprivation (0.96 [0.93-0.99] and 0.96 [0.95-0.97]), respectively, and males and the younger age group (<65 years) showed a more prominent association with greenness than in females and the elderly group (65 years or older). In addition, only high-population-density areas showed evident associations of greenness with both strong and mild sleep deprivation. CONCLUSIONS: This large population-based study provides important epidemiological evidence for improving sleep quantity through an increase in greenness exposure and supports policymakers in establishing strategies for urban planning.

Joint effect of heat and air pollution on mortality in 620 cities of 36 countries.

BACKGROUND: The epidemiological evidence on the interaction between heat and ambient air pollution on mortality is still inconsistent. OBJECTIVES: To investigate the interaction between heat and ambient air pollution on daily mortality in a large dataset of 620 cities from 36 countries. METHODS: We used daily data on all-cause mortality, air temperature, particulate matter ≤ 10 µm (PM10), PM ≤ 2.5 µm (PM2.5), nitrogen dioxide (NO2), and ozone (O3) from 620 cities in 36 countries in the period 1995-2020. We restricted the analysis to the six consecutive warmest months in each city. City-specific data were analysed with over-dispersed Poisson regression models, followed by a multilevel random-effects meta-analysis. The joint association between air temperature and air pollutants was modelled with product terms between non-linear functions for air temperature and linear functions for air pollutants. RESULTS: We analyzed 22,630,598 deaths. An increase in mean temperature from the 75th to the 99th percentile of city-specific distributions was associated with an average 8.9 % (95 % confidence interval: 7.1 %, 10.7 %) mortality increment, ranging between 5.3 % (3.8 %, 6.9 %) and 12.8 % (8.7 %, 17.0 %), when daily PM10 was equal to 10 or 90 µg/m3, respectively. Corresponding estimates when daily O3 concentrations were 40 or 160 µg/m3 were 2.9 % (1.1 %, 4.7 %) and 12.5 % (6.9 %, 18.5 %), respectively. Similarly, a 10 µg/m3 increment in PM10 was associated with a 0.54 % (0.10 %, 0.98 %) and 1.21 % (0.69 %, 1.72 %) increase in mortality when daily air temperature was set to the 1st and 99th city-specific percentiles, respectively. Corresponding mortality estimate for O3 across these temperature percentiles were 0.00 % (-0.44 %, 0.44 %) and 0.53 % (0.38 %, 0.68 %). Similar effect modification results, although slightly weaker, were found for PM2.5 and NO2. CONCLUSIONS: Suggestive evidence of effect modification between air temperature and air pollutants on mortality during the warm period was found in a global dataset of 620 cities.

Global short-term mortality risk and burden associated with tropical cyclones from 1980 to 2019: a multi-country time-series study.

BACKGROUND: The global spatiotemporal pattern of mortality risk and burden attributable to tropical cyclones is unclear. We aimed to evaluate the global short-term mortality risk and burden associated with tropical cyclones from 1980 to 2019. METHODS: The wind speed associated with cyclones from 1980 to 2019 was estimated globally through a parametric wind field model at a grid resolution of 0·5°â€ˆ× 0·5°. A total of 341 locations with daily mortality and temperature data from 14 countries that experienced at least one tropical cyclone day (a day with maximum sustained wind speed associated with cyclones ≥17·5 m/s) during the study period were included. A conditional quasi-Poisson regression with distributed lag non-linear model was applied to assess the tropical cyclone-mortality association. A meta-regression model was fitted to evaluate potential contributing factors and estimate grid cell-specific tropical cyclone effects. FINDINGS: Tropical cyclone exposure was associated with an overall 6% (95% CI 4-8) increase in mortality in the first 2 weeks following exposure. Globally, an estimate of 97 430 excess deaths (95% empirical CI [eCI] 71 651-126 438) per decade were observed over the 2 weeks following exposure to tropical cyclones, accounting for 20·7 (95% eCI 15·2-26·9) excess deaths per 100 000 residents (excess death rate) and 3·3 (95% eCI 2·4-4·3) excess deaths per 1000 deaths (excess death ratio) over 1980-2019. The mortality burden exhibited substantial temporal and spatial variation. East Asia and south Asia had the highest number of excess deaths during 1980-2019: 28 744 (95% eCI 16 863-42 188) and 27 267 (21 157-34 058) excess deaths per decade, respectively. In contrast, the regions with the highest excess death ratios and rates were southeast Asia and Latin America and the Caribbean. From 1980-99 to 2000-19, marked increases in tropical cyclone-related excess death numbers were observed globally, especially for Latin America and the Caribbean and south Asia. Grid cell-level and country-level results revealed further heterogeneous spatiotemporal patterns such as the high and increasing tropical cyclone-related mortality burden in Caribbean countries or regions. INTERPRETATION: Globally, short-term exposure to tropical cyclones was associated with a significant mortality burden, with highly heterogeneous spatiotemporal patterns. In-depth exploration of tropical cyclone epidemiology for those countries and regions estimated to have the highest and increasing tropical cyclone-related mortality burdens is urgently needed to help inform the development of targeted actions against the increasing adverse health impacts of tropical cyclones under a changing climate. FUNDING: Australian Research Council and Australian National Health and Medical Research Council.

Coffee intake and hypertension in Korean adults: results from KNHANES 2012-2016.

BACKGROUND: Coffee is the most popular and widely consumed drink in the world. Coffee consumption seems to have both benefits and risk with respect to hypertension; results from studies evaluating effect of frequency of coffee consumption on risk of hypertension are mixed and inconsistent. Hence, we investigated the association of coffee consumption and hypertension in Korean adults. METHODS: Data from Korean National Health and Nutrition Examination Survey (KNHANES) 2012-2016 was obtained and 12,133 eligible participants were selected. The coffee consumption was attained using a food frequency questionnaire. Subsequently coffee intake was grouped into two categories: ≤2 and > 2 servings per day. Hypertension status was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, use of antihypertensive drug treatment, or both. Multivariable logistic regression analysis was used to examine the association of coffee consumption and hypertension. RESULTS: Logistic regression analysis showed that consumption of more than two servings of coffee a day was inversely associated with hypertension with odds ratio (OR) 0.84 (95% confidence interval [CI], 0.73-0.99). Similar results were seen in the propensity score-matched analysis (OR, 0.83; 95% CI, 0.69-0.98). Adults having age more than median value (OR, 0.76; 95% CI, 0.65-0.89) and normal cholesterol (OR, 0.84; 95% CI, 0.70-0.99) had significantly inverse association with hypertension, when coffee consumption was more than two servings daily. CONCLUSIONS: More than two servings of coffee intake per day was inversely associated with hypertension as compared to consumption of ≤ 2 servings coffee per day.

The effect of residential greenness during pregnancy on infant neurodevelopment using propensity score weighting: A prospective mother-infant paired cohort study.

BACKGROUND: While prior studies have suggested an association between green spaces and infant neurodevelopment, the causal effect of green space exposure during pregnancy has not been fully investigated. This study aimed to identify with causal inference the effect of exposure to residential greenness during pregnancy on infants' mental-psychomotor development and the role of maternal education in modifying this association. METHODS: We prospectively collected data of pregnant women and their infants from Mothers and Children Environmental Health cohort study. Based on residential addresses, we compiled information on the percent of green space using different buffer distances (100 m, 300 m, and 500 m) and air pollution (PM2.5). Infant neurodevelopment was measured at 6 months of age using the Korean Bayley Scales of Infant Development II Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI). Generalized propensity scores (GPSs) were estimated from machine-learning (ML) algorithms. We deduced causal inference through GPS adjustment and weighting approaches. Further analyses confirmed whether the association was altered by maternal academic background. RESULTS: A total of 845 mother-infant pairs from the cohort study were included. We found that exposure to green spaces was robustly associated with infants' mental development. For example, an increase in % green space within 300 m increased the MDI by 14.32 (95 % confidence interval [CI], 3.44-25.2) in the weighting approach. Additionally, the association was even more noticeable for mothers with college degrees or above: an increase in % green space within 300 m increased the MDI by 23.69 (95 % CI, 8.53-38.85) and the PDI by 22.45 (95 % CI, 2.58-42.33) in the weighting approach. This association did not appear in mothers without college degrees. CONCLUSION: Exposure to green spaces during pregnancy showed a beneficial relationship with infant mental development. Maternal academic background could modify the impact of green space exposure on infant neurodevelopment.

Hospital admission risks and excess costs for neurological symptoms attributable to long-term exposure to fine particulate matter in New York State, USA.

BACKGROUND: Although emerging evidence suggests that PM2.5 is linked to neurological symptoms (NSs) via neuroinflammation, relevant studies are scarce. This study aimed to investigate the risks and excess costs of hospital admission for five NSs-fatigue, headache, dizziness, convulsion, and paralysis-attributable to long-term exposure to PM2.5 in New York State, USA. METHODS: We analyzed the New York Statewide Planning and Research Cooperative System (SPARCS) from 2010 to 2016. A Bayesian hierarchical model with integrated nested Laplace approximations was performed to estimate the risks and excess costs of hospital admission for NSs due to long-term exposure to PM2.5 at the county level. RESULTS: A 1 µg/m3 increase in lag 0-1 years PM2.5 was associated with an increased risk of headache and convulsion by 1.06 (1.01, 1.11) and 1.04 (1.01, 1.06), respectively. The excess hospital admission cost for five NSs attributable to lag 0-1 years PM2.5 above the new World Health Organization guideline (annual standard: 5 µg/m3) was $200.24 (95% CI: 6.00, 376.96) million during 2011-2016, recording the highest for convulsion ($153.73 [95% CI: 63.61, 244.19] million). CONCLUSIONS: This study provides quantitative estimates of risks and excess costs for NSs attributable to long-term PM2.5 and suggests that policies that reduce long-term PM2.5 concentration in accordance with the new WHO air quality guidelines can yield substantial health and economic benefits related to NSs in the New York State population.

COVID-19, maternal, and neonatal outcomes: National Mother-Child Cohort (NMCC) of K-COV-N cohort in South Korea.

Throughout the COVID-19 pandemic, pregnant women have been classified as a vulnerable population. However, the evidence on the effect of infection during pregnancy on maternal and neonatal outcomes is still uncertain, and related research comprising a large population of pregnant women in Asian countries is limited. We constructed a national cohort including mothers and children (369,887 pairs) registered in the Prevention Agency-COVID-19-National Health Insurance Service (COV-N), from January 1, 2020 to March 31, 2022. We performed propensity score matchings and generalized estimation equation models to estimate the effect of COVID-19 on maternal and neonatal outcomes. In summary, we found little evidence of the effect of COVID-19 infection during pregnancy on maternal and neonatal outcomes; however, a relationship between COVID-19 infection in the second trimester and postpartum hemorrhages was discovered (Odds ratio (OR) of Delta period: 2.26, 95% Confidence intervals (CI): 1.26, 4.05). In addition, neonatal intensive care unit (NICU) admissions increased due to COVID-19 infection (pre-Delta period: 2.31, 95% CI: 1.31, 4.10; Delta period: 1.99, 95% CI: 1.47, 2.69; Omicron period: 2.36, 95% CI: 1.75, 3.18). Based on the national retrospective cohort study data, this study investigated the effects of COVID-19 infection on maternal and neonatal outcomes in Korea from the pre-Delta to the initial Omicron epidemic periods. Our evidence suggests that the timely and successful policies of the government and academia in response to COVID-19 infections in newborns in Korea may cause an increase in NICU admissions, but nonetheless, they prevent adverse maternal and neonatal outcomes simultaneously.

Air Pollution and Acute Kidney Injury in the U.S. Medicare Population: A Longitudinal Cohort Study.

BACKGROUND: Recent studies have reported the association between air pollution exposure and reduced kidney function. However, it is unclear whether air pollution is associated with an increased risk of acute kidney injury (AKI). OBJECTIVES: To address this gap in knowledge, we investigated the effect estimates of long-term exposures to fine particulate matter [PM ≤2.5µm in aerodynamic diameter (PM2.5)], nitrogen dioxide (NO2), and ozone (O3) on the risk of first hospital admission for AKI using nationwide Medicare data. METHODS: This nationwide population-based longitudinal cohort study included 61,300,754 beneficiaries enrolled in Medicare Part A fee-for-service (FFS) who were ≥65 years of age and resided in the continental United States from the years 2000 through 2016. We applied Cox-equivalent Poisson models to estimate the association between air pollution and first hospital admission for AKI. RESULTS: Exposure to PM2.5, NO2, and O3 was associated with increased risk for first hospital admission for AKI, with hazard ratios (HRs) of 1.17 (95% CI: 1.16, 1.19) for a 5-µg/m3 increase in PM2.5, 1.12 (95% CI: 1.11, 1.13) for a 10-ppb increase in NO2, and 1.03 (95% CI: 1.02, 1.04) for a 10-ppb increase in summer-period O3 (June to September). The associations persisted at annual exposures lower than the current National Ambient Air Quality Standard. DISCUSSION: This study found an association between exposures to air pollution and the risk of the first hospital admission with AKI, and this association persisted even at low concentrations of air pollution. Our findings provide beneficial implications for public health policies and air pollution guidelines to alleviate health care expenditures and the disease burden attributable to AKI. https://doi.org/10.1289/EHP10729.