Journal of Preventive Medicine and Public Health

Original Articles

Trends in the Prevalence of Childhood Asthma in Seoul Metropolitan City, Korea: The Seoul Atopy ∙ Asthma-friendly School Project: Yong Min Cho, Chea-Bong Kim, Kyung Nam Yeon, Eun Sun Lee, KyooSang Kim; J Prev Med Public Health. 2018;51(6):275-280. Published online October 8, 2018; DOI: https://doi.org/10.3961/jpmph.18.090

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Objectives
The project Seoul Atopy ∙ Asthma-friendly School investigated the current status of childhood asthma to enable formulation of a preventative policy. We evaluated the current prevalence of childhood asthma in Seoul and its trends and related factors.
Methods
The project was conducted annually from 2011 to 2016 and involved around 35 000 children aged 1-13 years. Based on the International Study of Asthma and Allergies in Childhood guidelines, the survey involved parents. The associations of the particulate matter (PM10) concentration, and the number of days on which the daily air quality guidance level was exceeded in the 25 districts of Seoul, with the prevalence of asthma were assessed.
Results
The age-standardized asthma prevalence in 2011 and 2016 was 6.74 and 4.02%, respectively. The prevalence of lifetime asthma treatment and treatment during the last 12 months tended to decrease from 2011 to 2016. Asthma treatment was significantly correlated with the number of days on which the daily air quality guidance level was exceeded, but not with the PM10 concentration.
Conclusions
This study reports the prevalence of asthma among children in Seoul and confirmed the relationship between childhood asthma and known risk factors in a large-scale survey.

Summary

Korean summary
서울시 아토피 천식 안심학교 사업을 통하여 2011년부터 2016년까지 약 25만명의 아동들을 대상으로 천식 유병률을 파악하고 관련 요인을 분석하였다. 천식의 연령표준화 유병률은 2011년 6.745에서 2016년 4.02%로 감소 추세를 보였다. 미세먼지(PM10)의 농도가 기준을 초과한 일수는 천식으로 인한 병원 치료 건 수와 상관성을 보였다.

Citations

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Short-term Effects of Ambient Air Pollution on Emergency Department Visits for Asthma: An Assessment of Effect Modification by Prior Allergic Disease History: Juhwan Noh, Jungwoo Sohn, Jaelim Cho, Seong-Kyung Cho, Yoon Jung Choi, Changsoo Kim, Dong Chun Shin; J Prev Med Public Health. 2016;49(5):329-341. Published online September 8, 2016; DOI: https://doi.org/10.3961/jpmph.16.038

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Abstract PDF Supplementary Material

Objectives
The goal of this study was to investigate the short-term effect of ambient air pollution on emergency department (ED) visits in Seoul for asthma according to patients’ prior history of allergic diseases.
Methods
Data on ED visits from 2005 to 2009 were obtained from the Health Insurance Review and Assessment Service. To evaluate the risk of ED visits for asthma related to ambient air pollutants (carbon monoxide [CO], nitrogen dioxide [NO2], ozone [O3], sulfur dioxide [SO2], and particulate matter with an aerodynamic diameter <10 μm [PM10]), a generalized additive model with a Poisson distribution was used; a single-lag model and a cumulative-effect model (average concentration over the previous 1-7 days) were also explored. The percent increase and 95% confidence interval (CI) were calculated for each interquartile range (IQR) increment in the concentration of each air pollutant. Subgroup analyses were done by age, gender, the presence of allergic disease, and season.
Results
A total of 33 751 asthma attack cases were observed during the study period. The strongest association was a 9.6% increase (95% CI, 6.9% to 12.3%) in the risk of ED visits for asthma per IQR increase in O3 concentration. IQR changes in NO2 and PM10 concentrations were also significantly associated with ED visits in the cumulative lag 7 model. Among patients with a prior history of allergic rhinitis or atopic dermatitis, the risk of ED visits for asthma per IQR increase in PM10 concentration was higher (3.9%; 95% CI, 1.2% to 6.7%) than in patients with no such history.
Conclusions
Ambient air pollutants were positively associated with ED visits for asthma, especially among subjects with a prior history of allergic rhinitis or atopic dermatitis.

Summary

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Review

Short-term Effect of Fine Particulate Matter on Children’s Hospital Admissions and Emergency Department Visits for Asthma: A Systematic Review and Meta-analysis: Hyungryul Lim, Ho-Jang Kwon, Ji-Ae Lim, Jong Hyuk Choi, Mina Ha, Seung-Sik Hwang, Won-Jun Choi; J Prev Med Public Health. 2016;49(4):205-219. Published online July 14, 2016; DOI: https://doi.org/10.3961/jpmph.16.037

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49 Crossref

Abstract PDF

Objectives
No children-specified review and meta-analysis paper about the short-term effect of fine particulate matter (PM_2.5) on hospital admissions and emergency department visits for asthma has been published. We calculated more precise pooled effect estimates on this topic and evaluated the variation in effect size according to the differences in study characteristics not considered in previous studies.
Methods
Two authors each independently searched PubMed and EMBASE for relevant studies in March, 2016. We conducted random effect meta-analyses and mixed-effect meta-regression analyses using retrieved summary effect estimates and 95% confidence intervals (CIs) and some characteristics of selected studies. The Egger’s test and funnel plot were used to check publication bias. All analyses were done using R version 3.1.3.
Results
We ultimately retrieved 26 time-series and case-crossover design studies about the short-term effect of PM_2.5 on children’s hospital admissions and emergency department visits for asthma. In the primary meta-analysis, children’s hospital admissions and emergency department visits for asthma were positively associated with a short-term 10 μg/m³ increase in PM_2.5 (relative risk, 1.048; 95% CI, 1.028 to 1.067; I²=95.7%). We also found different effect coefficients by region; the value in Asia was estimated to be lower than in North America or Europe.
Conclusions
We strengthened the evidence on the short-term effect of PM_2.5 on children’s hospital admissions and emergency department visits for asthma. Further studies from other regions outside North America and Europe regions are needed for more generalizable evidence.

Summary

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Original Articles

A 9-year Trend in the Prevalence of Allergic Disease Based on National Health Insurance Data: Byoungin Yoo, Yoonhyung Park, Kwanjun Park, Hoseob Kim; J Prev Med Public Health. 2015;48(6):301-309. Published online November 13, 2015; DOI: https://doi.org/10.3961/jpmph.15.011

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Abstract PDF Supplementary Material

Objectives
To investigate trends in the prevalence of allergic disease over a 9-year period.
Methods
Using National Health Insurance Service (NHIS) data, the annual number of patients with allergic disease was obtained for each regional subdivisions (small cities, counties, and districts) from 2003 to 2011. Annual populations for each sub-region were obtained and used to calculate the standardized prevalence. To compare prevalence within the study period, data was standardized spatially and temporally. For standardization, demographic data was used to obtain the registered population and demographic structure for 2010, which was used to perform direct standardization of previous years. In addition, a geographic information system (GIS) was used to visualize prevalence for individual sub-regions, and allergic diseases were categorized into five groups according to prevalence.
Results
The nationwide outpatient prevalence of allergic rhinitis increased approximately 2.3-fold, from 1.27% in 2003 to 2.97% in 2013, while inpatient prevalence also increased approximately 2.4-fold,. The outpatient prevalence of asthma increased 1.2-fold, and inpatient prevalence increased 1.3-fold. The outpatient prevalence of atopic dermatitis decreased approximately 12%, and inpatient prevalence decreased 5%.
Conclusions
There was a large difference between prevalence estimated from actual treatment data and prevalence based on patients’ self-reported data, particularly for allergic rhinitis. Prevalence must continually be calculated and trends should be analyzed for the efficient management of allergic diseases. To this end, prevalence studies using NHIS claims data may be useful.

Summary

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Influence of Asthma on the Longitudinal Trajectories of Cigarette Use Behaviors From Adolescence to Adulthood Using Latent Growth Curve Models: Jisuk Bae; J Prev Med Public Health. 2015;48(2):111-117. Published online March 24, 2015; DOI: https://doi.org/10.3961/jpmph.14.053

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Abstract PDF

Objectives
While epidemiologic research indicates that the prevalence of risk-taking behaviors including cigarette smoking among young people with asthma is substantial, the longitudinal patterns of cigarette smoking in this vulnerable population have received little attention. The aim of this study was to evaluate differences in the longitudinal trajectories of cigarette use behaviors from adolescence to adulthood between young people with and without asthma.
Methods
Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) during the years 1994 to 1995 (Wave I, adolescence), 2001 to 2002 (Wave III, young adulthood), and 2007 to 2008 (Wave IV, adulthood) were analyzed (n=12 244). Latent growth curve models were used to examine the longitudinal trajectories of cigarette use behaviors during the transition to adulthood according to asthma status.
Results
Regardless of asthma status, the trajectory means of cigarette use behaviors were found to increase, and then slightly decrease from adolescence to adulthood. In total participants, there were no statistically significant differences in initial levels and changes in cigarette use behaviors according to asthma status. However, in select sex and race subgroups (i.e., females and non-whites), former asthmatics showed greater escalation in cigarette use behaviors than did non-asthmatics or current asthmatics.
Conclusions
This study indicated that the changing patterns of cigarette use behaviors during the transition to adulthood among young people with asthma are comparable to or even more drastic than those among young people without asthma.

Summary

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The Relationship Between Psychosocial Stress and Allergic Disease Among Children and Adolescents in Gwangyang Bay, Korea: Mee-Ri Lee, Bu-Soon Son, Yoo-Ri Park, Hye-Mi Kim, Jong-Youn Moon, Yong-Jin Lee, Yong-Bae Kim; J Prev Med Public Health. 2012;45(6):374-380. Published online November 29, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.6.374

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Abstract PDF

Objectives

Stress is considered a causal factor in many diseases, allergic disease being one of them. The prevalence of allergic disease is increasing in Korea, but the relationship between allergic symptoms and stress is not empirically well known. We aimed to evaluate the relationship between allergy-related symptoms and stress in children and adolescents.

Methods

We investigated 698 children and adolescents living in Gwangyang Bay, Korea, using a multi-stage cluster sampling method. Using the International Study of Asthma and Allergies in Childhood and the Psychosocial Well-being Index, these subjects were surveyed on allergy-related symptoms and psychosocial stressors in their lives, respectively. We used a multivariate logistic analysis for odds ratios for the complaint rate of allergic symptoms, after adjusting for age, gender, household income, body mass index, and residence.

Results

After adjustments, lifetime rhinitis (odds ratio [OR], 1.024), rhinoconjunctivitis (OR, 1.090), diagnosis of itchy eczema (OR, 1.040), treatment of itchy eczema (OR, 1.049), 12-month allergic conjunctivitis (OR, 1.026), diagnosis of allergic conjunctivitis (OR, 1.031), and treatment of allergic conjunctivitis (OR, 1.034) were found to be significantly associated with stress.

Conclusions

Our results support the notion that there is a relationship between stress and allergic symptoms in children and adolescents. Further research into any causal relationship between stress and allergies, as well as preventative public health plans for decreasing stress in children and adolescents are needed.

Summary

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Atefeh Sadeghi, Saeed Pazhoohan, Saeed Hajihashemi, Mohammad Reza Palizvan, Morteza Valizadeh
Respiratory Physiology & Neurobiology.2022; 298: 103847. CrossRef
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Shuai Hao, Fang Yuan, Pai Pang, Bo Yang, Xuejun Jiang, Aihui Yan
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Jingru Cheng, Fei Li, Yigui Lai, Jieyu Chen, Xiaomin Sun, Lei Xiang, Pingping Jiang, Shengwei Wu, Ya Xiao, Lin Zhou, Ren Luo, Xiaoshan Zhao, Yanyan Liu
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Misa Iio, Mana Hamaguchi, Mayumi Nagata, Koichi Yoshida
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So Young Kim, Min-Su Kim, Bumjung Park, Jin-Hwan Kim, Hyo Geun Choi, Luo Zhang
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Modifying Effect of Suicidal Ideation on the Relationship Between Asthma and Cigarette Use Behaviors Among Korean Adolescents: Jisuk Bae, Eun Young Park, Soon-Woo Park; J Prev Med Public Health. 2011;44(3):118-124. Published online May 17, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.3.118

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Abstract PDF

Objectives

Although cigarette smoking is known to be related to the exacerbation of asthma symptoms, several studies have indicated that the prevalence of cigarette smoking among asthmatic adolescents is similar to or even higher than that among non-asthmatic adolescents. The aim of this study was to evaluate the relationship between asthma and cigarette use behaviors and whether or not the presence of suicidal ideation modifies this relationship among Korean adolescents.

Methods

We analyzed data from the 2008 Korea Youth Risk Behavior Web-based Survey, which included a nationally representative sample of middle and high school students. Multiple logistic regression models were used to calculate odd ratios and 95% confidence intervals of cigarette use behaviors among current asthmatics, former asthmatics, and non-asthmatics, after adjusting for gender, grade, school records, socioeconomic status, current alcohol use, and suicidal ideation.

Results

Of 75 238 study participants, 3.5% were current asthmatics and 4.5% were former asthmatics. Compared with non-asthmatics, asthmatics were more likely to report current cigarette use, frequent and heavy cigarette use, and cigarette use before 13 years of age. There were statistically significant interactions between asthma and suicidal ideation in cigarette use behaviors.

Conclusions

This study demonstrated that asthmatic adolescents are more likely than non-asthmatic adolescents to engage in cigarette use behaviors and the presence of suicidal ideation is an effect modifier of the relationship between asthma and cigarette use behaviors. Particular attention should be paid to the awareness of health risks of cigarette smoking and mental health problems among asthmatic adolescents.

Summary

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Asthme et comportements suicidaires chez les adolescents: revue systématique
M. Underner, G. Peiffer, J. Perriot, I. De Chazeron, N. Jaafari
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English Abstract

Effects of Personal Exposure to Nitrogen Dioxide on Peak Expiratory Flow in Asthmatic Patients.: Ho Jang Kwon, Sang Gyu Lee, Young Koo Jee, Sang Rok Lee, Seung Sik Hwang; J Prev Med Public Health. 2007;40(1):59-63.; DOI: https://doi.org/10.3961/jpmph.2007.40.1.59

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Abstract PDF

OBJECTIVES
Nitrogen dioxide (NO2) has been inconsistently associated with gradual decreases in lung function. Here, we studied the effects of NO2 exposure in asthmatics by examining the association between changes in lung function and concentrations of NO2 which were personally measured. METHODS: Peak expiratory flow (PEF) and daily personal exposures to NO2 were recorded on 28 patients with asthma (confirmed by methacholine provocation test) over 4 weeks. We used generalized estimating equations to assess the relationship between personal NO2 exposure and PEF, adjusting for potential confounders such as age, gender, outdoor particulate matter, temperature, humidity, and exposure to environmental tobacco smoke. RESULTS: The personal NO2 exposures were higher than the corresponding ambient levels. The mean personal: ambient ratio for NO2 was 1.48. The personal NO2 exposures were not associated with the morning PEF, evening PEF, or the diurnal PEF variability. However, environmental tobacco smoke was negatively associated with both the morning and evening PEF. CONCLUSIONS: Among the asthmatic adults who participated in this study, we found no apparent impact of personal NO2 exposures on the peak expiratory flow.

Summary

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The statistical evaluation and comparison of ADMS-Urban model for the prediction of nitrogen dioxide with air quality monitoring network
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Environmental Monitoring and Assessment.2015;[Epub] CrossRef
Acute effects of air pollution on peak expiratory flow rates and symptoms among asthmatic patients in Chiang Mai, Thailand
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International Journal of Hygiene and Environmental Health.2011; 214(3): 251. CrossRef

Original Articles

Associations between Air Pollution and Asthma-related Hospital Admissions in Children in Seoul, Korea: A Case-crossover Study.: Jong Tae Lee; Korean J Prev Med. 2003;36(1):47-53.

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Abstract PDF: OBJECTIVES
I used a case-crossover design to investigate the association between air pollution, and hospital admissions for asthmatic children under the age of 15 years in Seoul, Korea METHODS: I estimated the changes in the levels of hospitalization risk from theinterquartile (IQR) increase in each pollutant concentrations, using conditional logistic regression analyses, with controls for weather information. RESULTS: Using bidirectional control sampling, the results from a conditional logistic regression model, with controls for weather conditions, showed the estimated relative risk of hospitalization for asthma among children to be 1.04 (95% confidence interval (CI), 1.01-1.08) for particulate matter with an aerodynamic diameter less than or equal to 10m (IQR=40.4ug/m3) ; 1.05 (95% CI, 1.00-1.09) for nitrogen dioxide (IQR=14.6ppb) ; 1.02 (95% CI, 0.97-1.06) for sulfur dioxide (IQR=4.4ppb) ; 1.03 (95% CI, 0.99-1.08) for ozone (IQR=21.7ppb) ; and 1.03 (95% CI, 0.99-1.08) for carbon monoxide (IQR=1.0ppm). CONCLUSIONS: This empirical analysis indicates the bidirectional control sampling methods, by design, would successfully control the confounding factors due to the long-term time trends of air pollution. These findings also support the hypothesis that air pollution, at levels below the current ambient air quality standards of Korea, is harmful to sensitive subjects, such as asthmatic children.; Summary

Effect of Air Pollution on Emergency Room Visits for Asthma: a Time Series Analysis.: Young Su Ju, Soo Hun Cho; Korean J Prev Med. 2001;34(1):61-72.

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Abstract PDF: OBJECTIVES
To evaluate the hypothesis that increasing ambient levels of ozone or particulate matter are associated with increased emergency room visits for asthma and to quantify the strength of association, if any, between these. METHODS: Daily counts of emergency room visits for asthma, air quality, and weather data were collected from hospitals with over 200 beds and from monitoring stations in Seoul, Korea from 1994 through 1997. Daily counts of emergency room visits for asthma attack were analyzed using a general additive Poisson model, with adjustment for the effects of secular trend, seasonal variation, Sunday and holiday, temperature, and humidity, according to levels of ozone and particulate matter. RESULTS: The association between daily counts of emergency room visits for asthma attack and ozone levels was statistically significant in summer(from June to August), and the RR by unit increment of 100 ppb ozone was 1.30(95% CI = 1.11-1.52) without lag time. With restriction of the period from April to September in 1996, the RR was 1.37(95% CI = 1.06-1.76), and from June to August in 1995, the RR was 1.62(95% CI = 1.12-2.35). In the data for children(5?14 yr), the RR was 2.57(95% CI = 1.31-5.05) with restriction of the period from April to September in 1997. There was no significant association between TSP levels and asthma attacks, but a slight association was seen between PM10 levels and asthma attacks in a very restricted period. CONCLUSION: There was a statistically significant association between ambient levels of ozone and daily counts of emergency room visits for asthma attack. Therefore, we must make efforts to effectively minimize air pollution, in order to protect public health.; Summary

Completeness Estimation of the Korean Medical Insurance Data in Childhood Asthma.: M N Ha, H J Kwon, D H Kang, S H Cho, K Y Yoo, Y S Joo, J H Sung, J W Kang, D S Kim, S I Lee; Korean J Prev Med. 1997;30(2):428-436.

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Abstract PDF: OBJECTIVES
: The purpose of this paper is to estimate the completeness of the Korean Medical Insurance Data in childhood asthma. METHODS : Capture-recapture method was used to estimate the prevalence of childhood asthma and case ascertainment rate(completeness) of Korean Medical Insurance Data using two source model, 'Korean Medical Insurance Committee Data (KMICD)' and 'Nationwide Study of Asthma and Allergies in Korean Children'. The asthma cases were restricted to those who were born from 1981 to 1989 and were identified by their Resident Register Number. Asthma cases in Korean Medical Insurance Data were defined as cases coded by ICD-9 493 and ICD-10 J45. In 'Nationwide Study of Asthma and Allergies in Korean Children', asthma cases were defined as the children who had been diagnosed asthma and had experienced symptoms of asthma during the past 12 months. The defined cases in two data sources were matched by 13 digits Resident Register Number. The numbers of matched patients in two data sources were 245 of 32,825 eligible total subjects. Chapman and Wittes' nearly unbiased estimation was used for capture-recapture analysis of two data sources. RESULTS : Observed prevalence rate of childhood asthma was 5.3% and estimated prevalence rate by capture-recapture analysis was 11.6%. The highest prevalence rate was observed in 6-7 age group and the older the rate decreased. The completeness (the proportion of cases ascertained by KMICD to the total observed cases by two data sources) was 20.6%, and ranged from 10.8% to 28.8% by area. CONCLUSIONS : Invalid diagnosis of cases might overestimate the prevalence of childhood asthma and might underestimate the completeness of Korean Medical Insurance Committee Data in this study; Summary

Respiratory Health of Foundry Workers Exposed to Binding Resin.: Jung Keun Choi, Chang Ok Rhee, Do Myung Paek, Byung Soon Choi, Yong Chul Shin, Ho Keun Chung; Korean J Prev Med. 1994;27(2):274-285.

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Abstract PDF: The effects of resin on the respiratory health have been investigated in 309 workers from four iron and steel foundries and the results compared with those from 122 workers who were not significantly exposed to resin gas and silica dust at the same industries. Phenol-formaldehyde resin was used in the core making and molding processes and workers were exposed to their decomposition products as well as to silica dist containing particulates The subjects were grouped according to formaldehyde, dust and other gas exposures, and smoking habits were considered also in the analysis. Standardized respiratory symptom questionnaire was administered by trained interviewers. Chest radiograph, pulmonary function tests, and methacholine challenge tests were done. Environmental measurements at the breathing zone were carried out to determine levels of formaldehyde, respirable dust and total dust. Foundry workers had a higher prevalence of symptoms of chronic bronchitis with chronic phlegm and chronic cough when exposed to dust. Exposure to gas was significantly associated with lowered FEV1 and obstructive pulmonary function changes. Exposure to formaldehyde and phenol gas was associated with wheezing symptom among workers, but FEV1 changes after methacholine challenge were not significantly different among different exposure groups. When asthma was defined as the presence of bronchial hyperreactivity with more than 20% decrease in FEV1 after methacholine challenge, 17 workers out of 222 tested had asthma. Fewer asthmatic workers were found among groups exposed to for maldehyde, gas and dust, which indicates a healthy worker effects in a cross-sectional study. The concentration of formaldehyde gas ranged from 0.24 to 0.43 ppm among studied foundries. The authors conclude that fornaldehyde and phenol gas from combust resin is probably the cause of asthmatic symptoms and also a selection force of those with higher bronchial reactivity away from exposures.; Summary

Health characteristics and symptom of workers in reactive dye industries.: Kyung Jong Lee, Young Hahn Moon, Jaehoon Roh, Hae Sim Park, Chein Soo Hong; Korean J Prev Med. 1990;23(3):338-344.

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Abstract PDF: This study investigated the symptoms, medical and occupational history of 424 workers of 5 reactive dye Industries in the Inchon area in Korea. The study was performed on March 6 and July 19, 1989. The tests applied to the subjects were: serum total IgE, skin prick test with 7 inhalatory antigens, pulmonary function test, chest X-ray, methacholine test, and bronchoprovocation test. The workers were classified according to these tests into 4 groups (healthy, realitively healthy, need careful medical observation, and occupational asthma), and were compared in terms of the group characteristics and the symptom prevalence. The prevalence of occupational asthma of workers in reactive dye was 5.9%. Significant differences were observed among the 4 groups. The groups were significantly different in the variables of sex and duration of smoking among their general characteristics ; asthma, bronchitis, and other respiratory diseases with respect to their past medical history. This study suggests that we should pay special attention to the workers exposed to the risk of occupational asthma.; Summary

English Abstracts

Cost-of-illness Study of Asthma in Korea: Estimated from the Korea National Health Insurance Claims Database.: Choon Seon Park, Hye Young Kang, Il Kwon, Dae Ryong Kang, Hye Young Jung; J Prev Med Public Health. 2006;39(5):397-403.

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Abstract PDF: OBJECTIVES
We estimated the asthma-related health care utilization and costs in Korea from the insurer's and societal perspective. METHODS: We extracted the insurance claims records from the Korea National Health Insurance claims database for determining the health care services provided to patients with asthma in 2003. Patients were defined as having asthma if they had > or =2 medical claims with diagnosis of asthma and they had been prescribed anti-asthma medicines. Annual claims records were aggeregated for each patient to produce patient-specific information on the total utilization and costs. The total asthma-related cost was the sum of the direct healthcare costs, the transportation costs for visits to healthcare providers and the patient's or caregivers' costs for the time spent on hospital or outpatient visits. RESULTS: A total of 699,603people were identified as asthma patients, yielding an asthma prevalence of 1.47%. Each asthma patient had 7.56 outpatient visits, 0.01 ED visits and 0.02 admissions per year to treat asthma.The per-capita insurance-covered costs increased with age, from 128,276 Won for children aged 1 to 14 years to 270,729 Won for those aged 75 or older. The total cost in the nation varied from 121,865 million to 174,949 million Won depending on the perspectives. From a societal perspective, direct healthcare costs accounted for 84.9%, transportation costs for 15.1% and time costs for 9.2% of the total costs. CONCLUSIONS: Hospitalizations and ED visits represented only a small portion of the asthma-related costs. Most of the societal burden was attributed to direct medical expenditures, with outpatient visits and medications emerging as the single largest cost components.; Summary

Effects of Air Pollution on Asthma in Seoul: Comparisons across Subject Characteristic.: Sun Young Kim, Ho Kim, Jaiyong Kim; J Prev Med Public Health. 2006;39(4):309-316.

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Abstract PDF: OBJECTIVES
Korean epidemiological studies have used reduced samples according to the subject's characteristics, such as the health services provided, the historical note with asthma, and age, to examine the acute effect of air pollution on asthma using the Korean National Health Insurance records. However, there have been few studies on whether the effects shown in these reduced samples are different from those of all samples. This study compared the effects of air pollution on asthma attacks in three reduced samples with those of entire samples. METHODS: The air pollution data for PM10, CO, SO2, NO2, and O3 and weather conditions including temperature, relative humidity, and air pressure in Seoul, 2002, were obtained from outdoor monitoring stations in Seoul. The emergency hospital visits with an asthma attack in Seoul, 2002 were extracted from the Korean National Health Insurance records. From these, the reduced samples were created by health service, historical notes with asthma, and age. A case-crossover design was adopted and the acute effects of air pollution on asthma were estimated after adjusting for weather, time trend, and seasonality. The model was applied to each reduced sample and the entire sample. RESULTS: With respect to the health service, the effects on outpatients were similar to those for the total sample but were different for inpatients. These similar effect sizes were also observed in the reduced samples according to the historical note with asthma and age. The relative risks of PM10, CO, SO2, NO2, and O3 among the reduced and entire samples were 1.03, 1.04-1.05, 1.02-1.03, 1.04-1.06, and 1.10-1.17, respectively. CONCLUSIONS: There was no clear evidence to show a difference between the reduced samples and the entire samples.; Summary

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