Hospital Visits, Admissions and Hospital Costs among Patients with Respiratory and Cardiovascular Diseases according to Particulate Matter in Seoul

서울지역 미세먼지 농도가 호흡기계 및 심혈관계의 외래 방문 및 입원과 진료비에 미치는 영향

  • Lee, Hyeong Suk (Seoul Women's College of Nursing College of Nursing, Seoul National University)
  • 이형숙 (서울여자간호대학교, 서울대학교 간호대학)
  • Received : 2016.07.13
  • Accepted : 2016.10.19
  • Published : 2016.10.31


Objectives: The annual average of PM10 in Seoul was $45{\mu}/m^3$, which surpasses the WHO annual guidelines ($20{\mu}/m^3$). Most previous analyses of the effects of PM exposure have been retrospective studies using single hospital data, and fewer studies have attempted to address the relationship of PM10 and hospital costs. This study was conducted to investigate the effects of the concentration of PM10 on hospital visits, admissions and hospital costs in patients with respiratory and cardiovascular diseases. Methods: Medical data from the National Health Insurance Service and the monthly average of PM10 from National Institute of Environmental Research were used to identify the effects of PM10 on hospital visits, admissions and hospital costs. We applied Poisson regression and linear regression to perform the analysis. Results: The relative risks for admissions per $10{\mu}/m^3$ increase in PM10 were 23.11%, 10.2% and 6.9% increases for acute bronchiolitis, asthma and bronchitis, respectively. The relative risk for hospital visits per $10{\mu}/m^3$ increase in PM10 were 10.4%, 6.7% and 5.9% for chronic obstructive pulmonary disease, asthma and chronic sinusitis, respectively. For cardiovascular disease, the relative risk for admissions per $10{\mu}/m^3$ increase in PM10 were 2.2% and 2.1% increases in angina and acute myocardial infarction, respectively. A $10{\mu}/m^3$ increase in the monthly average of PM10 corresponded to 170,723,000 won (95% CI: 125,587,000-215,860,000 won), 123,636,000 won (95% CI: 47,784,000-199,487,000 won) and 78,571,000 won (95% CI: 29,062,000-128,081,000 won) increases in hospital costs for asthma, acute tonsillitis and chronic sinusitis, respectively. Conclusion: Hospital admissions for respiratory and cardiovascular disease were associated with PM10 levels. PM10 exposure is also associated with increased costs for respiratory diseases.


Supported by : 서울여자간호대학교


  1. Devos S, Cox B, Dhondt S, Nawrot T, Putman K. Cost saving potential in cardiovascular hospital costs due to reduction in air pollution. Science of Total Environment. 2015; 527: 413-419.
  2. Dominici F, Peng RD, Bell ML, Pham L, McDermott A, Zeger SL, et al. Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. Journal of American Medical Association. 2006; 295(10): 1127-1134.
  3. Environmental Protection Agency. Integrated Science Assessment for Particulate Matter. Available: [accessed 13 July 2016]
  4. Pope CA, Burnett RT, Thurston GD, Thun MJ, Calle EE, Krewski D, et al. Cardiovascular mortality and long-term exposure to particulate air pollution epidemiological evidence of general pathophysiological pathways of disease. Circulation. 2004; 109(1): 71-77.
  5. Pope CA, Kalkstein LS. Synoptic weather modeling and estimates of the exposure-response relationship between daily mortality and particulate air pollution. Environmental Health Perspectives. 1996; 104(4), 414-420.
  6. World Health Organization. Ambient (outdoor) air quality and health. Available: [accessed 13 July 2016].
  7. Korea Ministry of Government Legislation. Enforcement Decree of the Clean Air Conservation Act. Available: [accessed 13 July 2016].
  8. Kim, YP. Air pollution in Seoul caused by aerosols. Journal of Korean Society for Atmospheric Environment. 2006; 22(5): 535-553.
  9. Park RS, Han GM. Contribution of long-range transported air pollution from China to particulate matter over Korean Peninsula. Journal of Korean Society of Hazard Mitigation. 2014; 14(2): 26-36.
  10. Park HJ, Woo KS, Chung EK, Kang TS, Kim GB, Yu SD, et al. A Time-series study of ambient air pollution in relation to daily mortality count in Yeosu. Journal of Environmental Impact Assessment. 2015; 24(1): 66-77.
  11. Bae, HJ. Effects of short-term exposure to PM10 and PM2.5 on mortality in Seoul. Journal of Environmental Health Sciences. 2014; 40(5): 346-354.
  12. On IB, Kim YH, Sim CS, Lee JH. Prevalence of children's allergic diseases in Ulsan: local differences and environmental risk factors. Journal of Environmental Health Sciences. 2012; 38(6): 472-481.
  13. Jang AS, Kim BY, Lee CH, Park JS, Lee JH, Park SW, et al. Hospital visits and admissions in patients with asthma, COPD, and cardiovascular diseases according to air pollutants. Korean Journal of Asthma, Allergy and Clinical Immunology. 2006; 26(3): 233-238.
  14. Korea Environment Coporation. International status of air pollution. Available: [accessed 13 July 2016].
  15. Kim BS. Air pollution exposure and cardiovascular disease. Toxicological Research. 2014; 30(2): 71-75.
  16. Perez L, Grize L, Infanger D, Kunzli N, Sommer H, Alt G M, et al. Associations of daily levels of PM10 and NO2 with emergency hospital admissions and mortality in Switzerland: trends and missed prevention potential over the last decade. Environmental Research. 2015; 140: 554-561.
  17. Zanobetti A, Schwartz J, Samoli E, Gryparis A, Touloumi G, Peacock J, et al. The temporal pattern of respiratory and heart disease mortality in response to air pollution. Environmental Health Perspectives. 2003; 111(9): 1188-1193.
  18. Oh IB, Sim CS, Lee JH. Prevalence of children's allergic diseases in Ulsan: local differences and environmental risk factors. Journal of Environmental Health Sciences. 2012; 38(6): 472-481.