Long-term fine particulate matter exposure and cardiovascular mortality in the general population: a nationwide cohort study

In Soo Kim, Pil Sung Yang, Jinae Lee, Hee Tae Yu, Tae Hoon Kim, Jae Sun Uhm, Jong Youn Kim, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


Background: Although eastern Asian countries are exposed to high levels of air pollution, the impact of long-term exposures to fine particulate matter (PM2.5) air pollution on all-cause and cardiovascular mortality is not well identified. We assessed the relationship between long-term PM2.5 exposure and all-cause/cardiovascular mortalities. Methods: We included 436,933 subjects who received national health examinations from the Korean National Health Insurance Service-based National Sample Cohort. We matched subjects’ residential-address areas with hourly-measurements of PM2.5 concentration data. We estimated the risk of mortality with average PM2.5 exposure during the study period using a Cox proportional-hazards model. Results: During 1,683,271 person·years, all-cause and cardiovascular mortalities were observed in 6432 and 1603 subjects (382 and 95 per 100,000 person·years, respectively). An increase in 10 μg/m3 in PM2.5 was associated with increases in all-cause and cardiovascular mortalities by 3.4 % [2.7–4.1] and 4.7 % [3.6–5.8], respectively (each p < 0.001). PM2.5 was linearly and significantly correlated with these all-cause and cardiovascular mortalities above 18 μg/m3 of PM2.5 (p < 0.001), but it was not significant below 18 μg/m3 of PM2.5. To investigate the specific PM2.5 concentration for raising cardiovascular mortality more, we analyzed the sensitivities/specificities for different PM2.5 levels, and 18 μg/m3 showed the highest Youden's index (sensitivity + specificity-1) with c-index of 0.85 (0.84–0.86). PM2.5 effect on all-cause mortality was more profound in subjects with previous myocardial infarction compared to the opposite population. Conclusions: In the Korean general population exposed to high-air pollution, long-term PM2.5 exposure was linearly associated with increased risk for all-cause and cardiovascular mortality, especially above 18 μg/m3 of PM2.5.

Original languageEnglish
Pages (from-to)549-558
Number of pages10
JournalJournal of Cardiology
Issue number5
Publication statusPublished - 2020 May

Bibliographical note

Funding Information:
This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology ( 2010-0021993 , NRF-2012R1A2A2A02045367 , NRF-2017R1A2B3003303 ), and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare ( HI16C0058 , HI15C1200 ). As a medical writer, IS K wrote this manuscript without any grants.

Publisher Copyright:
© 2020 Japanese College of Cardiology

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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