Air pollution, socioeconomic position, and emergency hospital visits for asthma in Seoul, Korea.
OBJECTIVE
Some epidemiological literature has observed that air pollution effects on health differed across regional or individual socioeconomic position. This study evaluated whether regional and individual socioeconomic position, as indicated by health insurance premiums, modified the effect of air pollution on hospital visits for asthma.


METHODS
Effects of ambient air pollutants (particulate matter, carbon monoxide, sulfur dioxide, nitrogen dioxide, and ozone) on 92,535 emergency out-patient hospital visits for asthma in Seoul, Korea during 2002 were estimated using case-crossover analysis, adjusting for time trend, weather conditions, and seasonality. Next, interactions between air pollutants and Korean National Health Insurance premium (1) for the individual patient and (2) averaged across the patient's residence district, were entered, first singly then jointly, in the models.


RESULTS
Relative risks of emergency outpatient hospital visits were all positively and significantly associated with interquartile increases for selected lags for all air pollutants. In the regression model with interaction terms for both individual premium and regional-average premium, associations with all five-air pollutants ranged from 1.03 to 1.09 times higher among the lowest premium districts compared to the highest premium districts. Of all the pollutants, nitrogen dioxide showed the strongest associations in lower premium districts compared to the higher premium districts. Individual socioeconomic position did not modify the associations in either the single or joint interaction models.


CONCLUSIONS
In Seoul, community but not individual socioeconomic conditions modified risk of asthma hospital visits on high air pollution days.
Kim
Sun-Young
SY
Department of Environment and Occupational Health Sciences, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA.
O'Neill
Marie S
MS
Lee
Jong-Tae
JT
Cho
Youngtae
Y
Kim
Jaiyong
J
Kim
Ho
H
D000328:Adult; D000368:Aged; D000397:Air Pollution / Q000009:adverse effects*; D001249:Asthma / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015987:Effect Modifier, Epidemiologic; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D007345:Insurance Claim Review; D007348:Insurance, Health / Q000706:statistics & numerical data; D007723:Korea / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000009:adverse effects / Q000032:analysis*; D012306:Risk; D012959:Socioeconomic Factors; D014504:Urban Health
D052638:Particulate Matter