Short-term effects of multiple outdoor environmental factors on risk of asthma exacerbations: Age-stratified time-series analysis.
TL;DR: The need for the development of tailored strategies to prevent asthma exacerbation events in different age groups is provided with the need for an age-stratified analysis of the short-term effects of environmental factors in Seoul Metropolitan City from 2008 and 2012.
Abstract: Background Although the different age groups had differences in sensitivity of asthma exacerbations (AEs) to environmental factors, no comprehensive study has examined the age-stratified effects of environmental factors on AEs. Objective We sought to examine the short-term effects in age-stratified groups (infants, preschool children, school-aged children, adults, and the elderly) of outdoor environmental factors (air pollutants, weather conditions, aeroallergens, and respiratory viral epidemics) on AEs. Methods We performed an age-stratified analysis of the short-term effects of 4 groups of outdoor environmental factors on AEs in Seoul Metropolitan City (Korea) from 2008 and 2012. The statistical analysis used a Poisson generalized linear regression model, with a distributed lag nonlinear model for identification of lagged and nonlinear effects and convergent cross-mapping for identification of causal associations. Results Analysis of the total population (n = 10,233,519) indicated there were 28,824 AE events requiring admission to an emergency department during the study period. Diurnal temperature range had significant effects in pediatric (infants, preschool children, and school-aged children) and elderly (relative risk [RR], 1.056-1.078 and 1.016, respectively) subjects. Tree and weed pollen, human rhinovirus, and influenza virus had significant effects in school-aged children (RR, 1.014, 1.040, 1.042, and 1.038, respectively). Tree pollen and influenza virus had significant effects in adults (RR, 1.026 and 1.044, respectively). Outdoor air pollutants (particulate matter of ≤10 μm in diameter, nitrogen dioxide, ozone, carbon monoxide, and sulfur dioxide) had significant short-term effects in all age groups (except for carbon monoxide and sulfur dioxide in infants). Conclusion These findings provide a need for the development of tailored strategies to prevent AE events in different age groups.
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TL;DR: It is found that asthma and allergic rhinitis were associated with worse clinical outcomes of COVID-19 in patients with SARS-CoV-2 positivity.
Abstract: Background There is inconclusive and controversial evidence of the association between allergic diseases and the risk of adverse clinical outcomes of coronavirus disease 2019 (COVID-19). Objective We sought to determine the association of allergic disorders with the likelihood of a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result and with clinical outcomes of COVID-19 (admission to intensive care unit, administration of invasive ventilation, and death). Methods A propensity-score–matched nationwide cohort study was performed in South Korea. Data obtained from the Health Insurance Review & Assessment Service of Korea from all adult patients (age, >20 years) who were tested for SARS-CoV-2 in South Korea between January 1, 2020, and May 15, 2020, were analyzed. The association of SARS-CoV-2 test positivity and allergic diseases in the entire cohort (n = 219,959) and the difference in clinical outcomes of COVID-19 were evaluated in patients with allergic diseases and SARS-CoV-2 positivity (n = 7,340). Results In the entire cohort, patients who underwent SARS-CoV-2 testing were evaluated to ascertain whether asthma and allergic rhinitis were associated with an increased likelihood of SARS-CoV-2 test positivity. After propensity score matching, we found that asthma and allergic rhinitis were associated with worse clinical outcomes of COVID-19 in patients with SARS-CoV-2 test positivity. Patients with nonallergic asthma had a greater risk of SARS-CoV-2 test positivity and worse clinical outcomes of COVID-19 than patients with allergic asthma. Conclusions In a Korean nationwide cohort, allergic rhinitis and asthma, especially nonallergic asthma, confers a greater risk of susceptibility to SARS-CoV-2 infection and severe clinical outcomes of COVID-19.
189 citations
29 Jan 2020
TL;DR: The results of this nationwide cross-sectional survey improve the understanding of the age-stratified epidemiology of allergic diseases in Korea and suggest the need for the development of tailored and precise strategies to prevent allergy diseases in different age groups.
Abstract: BACKGROUND Major questions remain regarding the age-stratified trends of allergic diseases and asthma in Korea. PURPOSE To identify the estimated recent prevalence and 10- year trends in asthma, allergic rhinitis, and atopic dermatitis among the Korean population from 2008 to 2017. METHODS This nationwide cross-sectional survey (Korean National Health and Nutrition Examination Survey) over 10 years (2008-2017) examined representative samples of the Korean population (n=85,006) including 2,131 infants, 4,352 preschool children, 12,919 school-age children, 44,200 adults, and 21,404 elderly adults. RESULTS In the 2016 to 2017 population, the estimated prevalence of asthma was 0.9% in infants, 2.3% in preschool children, 4.1% in school-age children, 2.3% in adults, and 4.1% in the elderly. The estimated prevalence of allergic rhinitis was 9.0%, 20.2%, 27.6%, 17.1%, and 6.9%, respectively. The estimated prevalence of atopic dermatitis was 5.9%, 11.3%, 14.6%, 3.9%, and 1.6%, respectively. Ten-year trends revealed a significant decrease in asthma prevalence in infants, preschool children, and the elderly. and in atopic dermatitis prevalence in infants and preschool children (P<0.05 for all trends). Furthermore, 10-year trends demonstrated a significant increase in allergic rhinitis prevalence in school-age children, adults, and the elderly, and in atopic dermatitis prevalence in school-age children and the elderly (P<0.05 for all trends). CONCLUSION These results improve our understanding of the age-stratified epidemiology of allergic diseases in Korea and suggest the need for the development of tailored and precise strategies to prevent allergic diseases in different age groups.
87 citations
Sejong University1, Yonsei University2, University of Ulsan3, Harvard University4, Brigham and Women's Hospital5, Case Western Reserve University6, University of Cambridge7, Catalan Institution for Research and Advanced Studies8, Linköping University9, Anglia Ruskin University10, Samsung Medical Center11, Norwegian Institute of Public Health12, Norwegian School of Sport Sciences13, Seoul National University Hospital14
TL;DR: In this article, the potential associations between physical activity and risk of SARS-CoV2 infection, severe illness from COVID-19 and COVID19 related death using a nationwide cohort from South Korea were determined.
Abstract: Purpose- To determine the potential associations between physical activity and risk of SARS-CoV-2 infection, severe illness from COVID-19 and COVID-19 related death using a nationwide cohort from South Korea.
Methods- Data regarding 212 768 Korean adults (age ≥20 years), who tested for SARS-CoV-2, from 1 January 2020 to 30 May 2020, were obtained from the National Health Insurance Service of South Korea and further linked with the national general health examination from 1 January 2018 to 31 December 2019 to assess physical activity levels. SARS-CoV-2 positivity, severe COVID-19 illness and COVID-19 related death were the main outcomes. The observation period was between 1 January 2020 and 31 July 2020.
Results- Out of 76 395 participants who completed the general health examination and were tested for SARS-CoV-2, 2295 (3.0%) were positive for SARS-CoV-2, 446 (0.58%) had severe illness from COVID-19 and 45 (0.059%) died from COVID-19. Adults who engaged in both aerobic and muscle strengthening activities according to the 2018 physical activity guidelines had a lower risk of SARS-CoV-2 infection (2.6% vs 3.1%; adjusted relative risk (aRR), 0.85; 95% CI 0.72 to 0.96), severe COVID-19 illness (0.35% vs 0.66%; aRR 0.42; 95% CI 0.19 to 0.91) and COVID-19 related death (0.02% vs 0.08%; aRR 0.24; 95% CI 0.05 to 0.99) than those who engaged in insufficient aerobic and muscle strengthening activities. Furthermore, the recommended range of metabolic equivalent task (MET; 500–1000 MET min/week) was associated with the maximum beneficial effect size for reduced risk of SARS-CoV-2 infection (aRR 0.78; 95% CI 0.66 to 0.92), severe COVID-19 illness (aRR 0.62; 95% CI 0.43 to 0.90) and COVID-19 related death (aRR 0.17; 95% CI 0.07 to 0.98). Similar patterns of association were observed in different sensitivity analyses.
Conclusion- Adults who engaged in the recommended levels of physical activity were associated with a decreased likelihood of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death. Our findings suggest that engaging in physical activity has substantial public health value and demonstrates potential benefits to combat COVID-19.
83 citations
TL;DR: In this article, the authors investigated whether the same applies to the pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is sensitive to antiviral interferons, if infection waves coincide with high airborne pollen concentrations.
Abstract: Pollen exposure weakens the immunity against certain seasonal respiratory viruses by diminishing the antiviral interferon response. Here we investigate whether the same applies to the pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is sensitive to antiviral interferons, if infection waves coincide with high airborne pollen concentrations. Our original hypothesis was that more airborne pollen would lead to increases in infection rates. To examine this, we performed a cross-sectional and longitudinal data analysis on SARS-CoV-2 infection, airborne pollen, and meteorological factors. Our dataset is the most comprehensive, largest possible worldwide from 130 stations, across 31 countries and five continents. To explicitly investigate the effects of social contact, we additionally considered population density of each study area, as well as lockdown effects, in all possible combinations: without any lockdown, with mixed lockdown-no lockdown regime, and under complete lockdown. We found that airborne pollen, sometimes in synergy with humidity and temperature, explained, on average, 44% of the infection rate variability. Infection rates increased after higher pollen concentrations most frequently during the four previous days. Without lockdown, an increase of pollen abundance by 100 pollen/m3 resulted in a 4% average increase of infection rates. Lockdown halved infection rates under similar pollen concentrations. As there can be no preventive measures against airborne pollen exposure, we suggest wide dissemination of pollen-virus coexposure dire effect information to encourage high-risk individuals to wear particle filter masks during high springtime pollen concentrations.
82 citations
TL;DR: The findings provide an improved understanding of the pathogenesis of asthma and its relationship with carcinogenesis, and suggest that clinicians should be aware of the higher risk of incident cancer among asthmatic patients.
Abstract: Background Evidence regarding the risk of cancer development after asthma diagnosis is controversial and inconclusive. Objective This study sought to determine whether asthma is associated with an increased risk for incident cancer. Methods Two independent, population-based, longitudinal cohorts were examined, and estimated hazard ratios were determined using Cox regression. One group consisted of an unmatched cohort of 475,197 participants and a propensity score–matched cohort of 75,307 participants from the National Health Insurance Service–National Sample Cohort (NHIS-NSC; claims-based data from 2003 to 2015). The other group consisted of 5,440 participants from the Ansan-Ansung cohort (interview-based data from 2001 to 2014). Results The NHIS-NSC matched cohort had 572,740 person-years of follow-up, 6,885 people with new asthma diagnoses, and 68,422 people without asthma diagnoses. Adults with asthma had a 75% greater risk of incident cancer overall. The excess risk for incident cancer was greatest during the first 2 years after asthma diagnosis, and this risk remained elevated throughout follow-up. Patients with nonatopic asthma had a greater risk of overall cancer than those with atopic asthma. A high cumulative dose of inhaled corticosteroids among asthma patients was associated with a 56% reduced risk of lung cancer, but had no effect on the risk of overall cancer. The results from the NHIS-NSC unmatched cohort and the Ansan-Ansung cohort were similar to the primary results from the NHIS-NSC matched cohort. Conclusions Asthma development was associated with an increased risk of subsequent cancer in 2 different Korean cohorts. Our findings provide an improved understanding of the pathogenesis of asthma and its relationship with carcinogenesis and suggest that clinicians should be aware of the higher risk of incident cancer among patients with asthma.
55 citations
References
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TL;DR: A new method, based on nonlinear state space reconstruction, that can distinguish causality from correlation is introduced, and extends to nonseparable weakly connected dynamic systems (cases not covered by the current Granger causality paradigm).
Abstract: Identifying causal networks is important for effective policy and management recommendations on climate, epidemiology, financial regulation, and much else. We introduce a method, based on nonlinear state space reconstruction, that can distinguish causality from correlation. It extends to nonseparable weakly connected dynamic systems (cases not covered by the current Granger causality paradigm). The approach is illustrated both by simple models (where, in contrast to the real world, we know the underlying equations/relations and so can check the validity of our method) and by application to real ecological systems, including the controversial sardine-anchovy-temperature problem.
1,591 citations
TL;DR: A modelling framework that can simultaneously represent non-linear exposure–response dependencies and delayed effects, based on the definition of a ‘cross-basis’, which is implemented in the package dlnm within the statistical environment R.
Abstract: Environmental stressors often show effects that are delayed in time, requiring the use of statistical models that are flexible enough to describe the additional time dimension of the exposure-response relationship. Here we develop the family of distributed lag non-linear models (DLNM), a modelling framework that can simultaneously represent non-linear exposure-response dependencies and delayed effects. This methodology is based on the definition of a 'cross-basis', a bi-dimensional space of functions that describes simultaneously the shape of the relationship along both the space of the predictor and the lag dimension of its occurrence. In this way the approach provides a unified framework for a range of models that have previously been used in this setting, and new more flexible variants. This family of models is implemented in the package dlnm within the statistical environment R. To illustrate the methodology we use examples of DLNMs to represent the relationship between temperature and mortality, using data from the National Morbidity, Mortality, and Air Pollution Study (NMMAPS) for New York during the period 1987-2000.
1,398 citations
TL;DR: The effects of particulate matter, gaseous pollutants (ozone, nitrogen dioxide, and sulphur dioxide), and mixed traffic-related air pollution are discussed, focusing on clinical studies published in the previous 5 years.
1,274 citations
TL;DR: Investigation of the relation between newly-diagnosed asthma and team sports in a cohort of children exposed to different concentrations and mixtures of air pollutants found air pollution and outdoor exercise could contribute to the development of asthma in children.
778 citations
TL;DR: To improve the accessibility of healthcare service researchers to claims data of HIRA, HIRA has developed the Patient Samples which are extracted using a stratified randomized sampling method.
Abstract: The claims data of the Health Insurance Review and Assessment Service (HIRA) is an important source of information for healthcare service research. The claims data of HIRA is collected when healthcare service providers submit a claim to HIRA to be reimbursed for a service that they provided to patients. To improve the accessibility of healthcare service researchers to claims data of HIRA, HIRA has developed the Patient Samples which are extracted using a stratified randomized sampling method. The Patient Samples of HIRA consist of five tables: a table for general information (Table 20) containing socio-demographic information such as gender, age and medical aid, indicators for inpatient and outpatient services; a table for specific information on healthcare services provided (Table 30); a table for diagnostic information (Table 40); a table for outpatient prescriptions (Table 53) and a table for information on healthcare service providers (Table of providers). Researchers who are interested in using the Patient Sample data for research can apply via HIRA’s website (https://www.hira.or.kr).
426 citations