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Jung J, Kim G, Kang SW, Jeong S, Kang Y, Lee JY, Myung W, Kim H, Lee H. Short-term exposure to ambient air pollution and injuries due to external causes according to intentions and mechanisms. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169202. [PMID: 38097073 DOI: 10.1016/j.scitotenv.2023.169202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023]
Abstract
Although injuries are a leading cause of death and affect the life expectancy of individuals who live with disabilities globally, the potential role of air pollution exposure on injuries due to external causes has received little scientific attention, especially compared with that given to the association of air pollution and non-external causes of morbidity and mortality. We investigated the association between emergency department visits for externally caused injuries and short-term exposure to major ambient air pollutants, with focus on the intentions and mechanisms of injuries. We identified 2,049,855 injured patients in Seoul, South Korea between 2008 and 2016 using the National Emergency Database. Daily short-term exposure to air pollution including particles <10 μm (PM10) and <2.5 μm (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) was estimated based on hourly concentrations. We employed a time-stratified case-crossover study design using a conditional Poisson regression model adjusted for meteorological variables, influenza epidemics, and holidays. Immediate exposure (lag 0) to most pollutants significantly increased the risk of total injuries (PM2.5, 0.42 %; NO2, 0.68 %; SO2, 1.05 %; CO, 0.57 %; O3, 1.86 % per interquartile range increment), and the associations differed according to the intention and mechanism of injury. Unintentional and assault injuries were significantly associated with air pollution exposure, whereas self-harm injuries showed no association. In mechanism-specific analyses, injuries caused by falls, blunt objects, penetration, traffic accidents, machinery, and slips were associated with specific air pollutants, even in the co-pollutant models. The associations were stronger in injured patients aged <15 years, and in males than in their counterparts. Our results suggest that short-term air pollution exposure might play a role in the risk of externally caused injuries and the association may differ depending on the intention and mechanism of injury, which provide important evidence for injury prevention and air quality strategies.
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Affiliation(s)
- Jiyun Jung
- Clinical Trial Center, Dongguk University Ilsan Hospital, Goyang, South Korea; Research Center for Chronic Disease and Environmental Medicine, Dongguk University College of Medicine, Gyeongju, South Korea
| | - Gyeongchan Kim
- Department of Health Administration and Management, Soonchunhyang University Graduate School, Asan, South Korea
| | - Sun-Woo Kang
- Department of Health Administration and Management, Soonchunhyang University Graduate School, Asan, South Korea
| | - Subin Jeong
- Department of Health Administration and Management, Soonchunhyang University Graduate School, Asan, South Korea
| | - Yoonjung Kang
- Department of Health Administration and Management, Soonchunhyang University Graduate School, Asan, South Korea
| | - Jun-Young Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ho Kim
- Department of Public Health Science, School of Public Health, Seoul National University, Seoul, South Korea
| | - Hyewon Lee
- Department of Health Administration and Management, Soonchunhyang University Graduate School, Asan, South Korea; Department of Health Administration and Management, College of Medical Sciences, Soonchunhyang University, Asan, South Korea; Department of Software Convergence, Soonchunhyang University Graduate School, Asan, South Korea.
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Liao KH, Chan TC, Wu CC, Huang WC, Hsu CW, Chuang HC, Wiratama BS, Chiu WT, Lam C. Association between short-term air pollution exposure and traumatic intracranial hemorrhage: pilot evidence from Taiwan. Front Neurol 2023; 14:1087767. [PMID: 37234787 PMCID: PMC10208221 DOI: 10.3389/fneur.2023.1087767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/17/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction The detrimental effects of air pollution on the brain are well established. However, few studies have examined the effect of air pollution on traumatic brain injury (TBI). This pilot study evaluated the association between short-term air pollution exposure and traumatic intracranial hemorrhage (TIH). Methods Hospital data of patients with TBI following road traffic accidents were retrospectively collected from the electronic medical records at five trauma centers in Taiwan between 1 January and 31 December 2017. TIH was employed as an outcome measure. All road accident locations were geocoded, and air quality data were collected from the nearest monitoring stations. Air pollutants were entered into five multivariable models. A sensitivity analysis was performed on patients who are vulnerable to suffering TBI after road accidents, including motorcyclists, bicyclists, and pedestrians. Results Among 730 patients with TBI, 327 had TIH. The ages of ≥65 [odds ratio (OR), 3.24; 95% confidence interval (CI), 1.85-5.70], 45-64 (OR, 2.61; 95% CI, 1.64-4.15), and 25-44 (OR, 1.79; 95% CI, 1.13-2.84) years were identified as significant risk factors in the multivariable analysis. In the best-fit multivariable model, exposure to higher concentrations of particulate matter ≤ 2.5 μm in aerodynamic diameter (PM2.5) was associated with an elevated TIH risk (OR, 1.50; 95% CI, 1.17-1.94). The concentration of nitrogen oxides (NOX) did not increase the risk of TIH (OR, 0.45; 95% CI, 0.32-0.61). After categorizing the air pollution concentration according to quartile, the trend tests in the multivariate model showed that the concentrations of PM2.5 and NOX were significant (p = 0.017 and p < 0.001, respectively). There was a negative borderline significant association between temperature and TIH risk (OR, 0.75; 95% CI, 0.56-1.00, p = 0.05). Notably, the single-vehicle crash was a significant risk factor (OR, 2.11; 95% CI, 1.30-3.42) for TIH. Discussion High PM2.5 concentrations and low temperatures are risk factors for TIH in patients with TBI. High NOX concentrations are associated with a lower TIH risk.
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Affiliation(s)
- Kuo-Hsing Liao
- Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Division of Critical Medicine, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Neurotraumatology and Intensive Care, Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- Division of Neurosurgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Chieh Wu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Emergency Department, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Education in Medical Simulation, Taipei Medical University, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chin-Wang Hsu
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Emergency Department, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Bayu Satria Wiratama
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wen-Ta Chiu
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- AHMC Health System, Alhambra, CA, United States
| | - Carlos Lam
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Lin HA, Chan CW, Wiratama BS, Chen PL, Wang MH, Chao CJ, Saleh W, Huang HC, Pai CW. Evaluating the effect of drunk driving on fatal injuries among vulnerable road users in Taiwan: a population-based study. BMC Public Health 2022; 22:2059. [DOI: 10.1186/s12889-022-14402-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/19/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Most studies have focused on injuries sustained by intoxicated drivers themselves, but few have examined the effect of drunk driving on injury outcomes among VRUs (vulnerable road users) in developing countries. This study aims to evaluate the effect of drunk driving on fatal injuries among VRUs (pedestrians, cyclists, or motorcyclists).
Methods
The data were extracted from the National Taiwan Traffic Crash Dataset from January 1, 2011, to December 31, 2019. Crashes involving one motorized vehicle and one VRU were considered. This study examines the effect of drunk driving by estimating multivariate logistic regression models of fatal injuries among VRUs after controlling for other variables.
Results
Among 1,416,168 casualties, the fatality rate of VRUs involved in drunk driving was higher than that of general road users (2.1% vs. 0.6%). Drunk driving was a significant risk factor for fatal injuries among VRUs. Other risk factors for fatal injuries among VRUs included VRU age ≥ 65 years (adjusted odds ratio [AOR]: 5.24, 95% confidence interval [CI]: 5.53–6.07), a nighttime accident (AOR: 4.52, 95% CI: 4.22–4.84), and being hit by a heavy-duty vehicle (AOR: 2.83, 95% CI: 2.26–3.55). Subgroup analyses revealed a linear relationship between driver blood alcohol concentration (BAC) and the risk of fatal injury among motorcyclists. Motorcyclists exhibited the highest fatality rate when they had a BAC ≤ 0.03% (AOR: 3.54, 95% CI: 3.08–4.08).
Conclusion
Drunk driving was associated with a higher risk of fatality for all VRUs. The risk of fatal injury among motorcyclists was linearly related to the BAC of the drunk drivers. Injuries were more severe for intoxicated motorcyclists, even those with BAC ≤ 0.03%, which is within the legal limit.
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Lin HY, Li JS, Pai CW, Chien WC, Huang WC, Hsu CW, Wu CC, Yu SH, Chiu WT, Lam C. Environmental Factors Associated with Severe Motorcycle Crash Injury in University Neighborhoods: A Multicenter Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10274. [PMID: 36011909 PMCID: PMC9407754 DOI: 10.3390/ijerph191610274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/20/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
University neighborhoods in Taiwan have high-volume traffic, which may increase motorcyclists' risk of injury. However, few studies have analyzed the environmental factors affecting motorcycle crash injury severity in university neighborhoods. In this multicenter cross-sectional study, we explored the factors that increase the severity of such injuries, especially among young adults. We retrospectively connected hospital data to the Police Traffic Accident Dataset. Areas within 500 m of a university were considered university neighborhoods. We analyzed 4751 patients, including 513 with severe injury (injury severity score ≥ 8). Multivariate analysis revealed that female sex, age ≥ 45 years, drunk driving, early morning driving, flashing signals, and single-motorcycle crashes were risk factors for severe injury. Among patients aged 18-24 years, female sex, late-night and afternoon driving, and flashing signals were risk factors. Adverse weather did not increase the risk. Time to hospital was a protective factor, reflecting the effectiveness of urban emergency medical services. Lifestyle habits among young adults, such as drunk driving incidents and afternoon and late-night driving, were also explored. We discovered that understanding chaotic traffic in the early morning, flashing signals at the intersections, and roadside obstacles is key for mitigating injury severity from motorcycle crashes in university neighborhoods.
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Affiliation(s)
- Heng-Yu Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Jian-Sing Li
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan
| | - Chih-Wei Pai
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei 11490, Taiwan
| | - Wen-Cheng Huang
- Emergency Department, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Center for Education in Medical Simulation, Taipei Medical University, Taipei 11031, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chin-Wang Hsu
- Emergency Department, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chia-Chieh Wu
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Shih-Hsiang Yu
- Institute of Transportation, Ministry of Transportation and Communications, Taipei 10548, Taiwan
| | - Wen-Ta Chiu
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
- AHMC Health System, Alhambra, CA 91801, USA
| | - Carlos Lam
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
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