Short-term Exposure to Air pollution and the Attributable Risk of Emergency Room Visits for Kidney Diseases

Abstract

BACKGROUND AND AIM: Several existing studies have shown that long-term exposure to air pollution is associated with reduced kidney function. However, less is known about the effects of short-term exposure to air pollution on kidney disease aggravation and resultant emergency department burden. This study aimed to estimate the excess emergency room (ER) visits attributable to the short-term air pollution and to suggest evidence on better air pollution standards to protect kidney patients. METHODS: We conducted a time-series study using the National Health Insurance data covering all persons in South Korea (2003-2013). We collected daily data for air pollutants (particulate matter 10µm [PM10], ozone [O3], carbon monoxide [CO], and sulfur dioxide [SO2]) and ER visits for total kidney disease, acute kidney injury (AKI), and chronic kidney disease (CKD), respectively. We performed a distributed lag model analyses to estimate excess ER visits attributable to air pollution. RESULTS:For all kidney disease, excess ER visits attributable to air pollution were statistically significant for all air pollutants. While, for AKI, O3 showed the highest impacts on excess ER visits compared to other pollutants. On the other hand, the impacts of CO and SO2 were the highest for CKD compared to O3 and PM10. We also found that the positive association between air pollution and kidney ER visits existed for days with air pollution concentrations below the current WHO air quality guidelines. CONCLUSIONS:This study provides estimates of excess ER burdens attributable to air pollution and suggests that stricter air quality standards would benefit kidney disease patients. KEYWORDS: Kidney disease, Emergency Room Burden, Short term exposure, Air pollution, WHO air quality guideline