Epidemiology and Health

Original Article

Association between long-term PM_2.5 exposure and risk of urticaria and allergic rhinitis in Korean children: a nationwide longitudinal cohort study: Young A Park, Hyemin Jang, Whanhee Lee, Jongmin Oh, Jung Won Lee, Hae Soon Kim, Jung Eun Choi, Rosie Lee, AiMS-CREATE, Ji Hyen Lee, Eun-Hee Ha; Epidemiol Health. 2026;48:e2026020. Published online May 7, 2026; DOI: https://doi.org/10.4178/epih.e2026020

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Exposure to air pollutants is well established as being associated with the development and exacerbation of asthma. However, relatively few studies have examined the relationship between fine particulate matter (PM2.5) exposure and the risk of urticaria and allergic rhinitis (AR). Therefore, this study aimed to investigate the associations between long-term PM2.5 exposure and the risks of urticaria and AR.

METHODS

We analyzed data from the Korean National Health Insurance Service–National Sample Cohort spanning 2002 to 2019. The cohort included individuals enrolled from birth and followed until the onset of urticaria or AR. Annual PM2.5 exposure was estimated using validated machine learning–based prediction models with high spatial resolution across mainland Korea. At the initial healthcare visit, urticaria and AR were identified based on primary diagnostic codes from the 10th revision of the International Classification of Diseases. Cox proportional hazards models with time-varying exposures and confounders were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risks associated with a 5 μg/m3 increase in annual PM2.5 concentration.

RESULTS

During follow-up, 364,227 individuals aged 0–18 years at enrollment were included, among whom 151,508 developed urticaria and 258,041 developed AR. The mean PM2.5 concentration at baseline was 29.6 μg/m3 (standard deviation, 3.1). The HR per 5 μg/m3 increase in annual PM2.5 concentration was 1.02 (95% CI, 1.01 to 1.03) for urticaria and 1.06 (95% CI, 1.05 to 1.07) for AR.

CONCLUSIONS

In this nationwide cohort, long-term exposure to PM2.5 was associated with the incidence of urticaria and AR. These findings provide important evidence for strategies aimed at preventing urticaria and AR in children.

Summary

Korean summary
장기간 PM2.5 노출은 국내 소아·청소년의 두드러기 및 알레르기비염 발생 위험 증가와 관련이 있었다. 전국 단위 코호트 연구에서 PM2.5 노출이 높을수록 알레르기질환 발생 위험이 증가하는 경향을 보였다. 본 연구 결과는 소아 알레르기질환 예방을 위한 대기질 개선의 중요성을 시사한다.

Key Message
Long-term exposure to PM2.5 was associated with increased risks of urticaria and allergic rhinitis in Korean children and adolescents. In this nationwide cohort study, higher PM2.5 exposure was consistently linked to a greater risk of developing allergic diseases. These findings underscore the importance of air quality improvement for the prevention of pediatric allergic diseases.

Citations

Citations to this article as recorded by

The dual challenge of climate change in otolaryngology: Environmental impacts on airway diseases and emission reduction strategies in surgical care
Nuray Bayar Muluk
International Journal of Biometeorology.2026;[Epub] CrossRef

Systematic Review

Adverse health effects of climate change and air pollution in people with disabilities: a systematic review: Nakyung Rhim, Seohyun Lee, Kyung-Hwa Choi; Epidemiol Health. 2024;46:e2024080. Published online September 27, 2024; DOI: https://doi.org/10.4178/epih.e2024080

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Abstract

Global warming and air pollution adversely affect the health of the entire human population, particularly older adults, people with disabilities (PWDs), and children. In this systematic review, we investigated the adverse health effects of climate change and air pollution in PWDs. We conducted a comprehensive literature search of the PubMed database using the terms “disab*,” “air pollution,” and “climate change” on July 4, 2023, and August 8, 2023 and searched the Web of Science (WOS) database on December 28, 2023. We identified 425 and 1,169 studies on climate change cited in PubMed and WOS, respectively, as well as 333 studies on air pollution in PubMed and 495 studies on air pollution in WOS. The studies were classified by type of exposure, and full-text screening was conducted to confirm that the population, intervention or exposure, comparator, outcome statement, and inclusion and exclusion criteria were met. The Newcastle-Ottawa Scale was used to assess the quality of the included cohort and case-control studies and for data analysis. In extreme temperatures, PWDs experienced higher rates of injury, heat-related illness, functional impairment, heart disease, mental disorders, and mortality than people who were non-disabled (ND). Exposure to air pollution resulted in higher rates of obesity, cardiovascular disease, poststroke neurological and functional disability, and mortality in PWDs than in people who were ND. Therefore, because PWDs were more affected by climate change and air pollution than people who were ND, sensitive policies and preparedness measures should be developed for PWDs.

Summary

Korean summary
전체 인구, 특히 취약 계층의 건강은 기후 변화와 대기 오염으로 인해 부정적인 영향을 받을 수 있습니다. 본 체계적 고찰 연구는 장애인이 비장애인에 비해 환경적 요인에 노출되어 더 심각한 신체적, 정신적 건강 문제를 겪는다는 것을 보여줍니다.

Key Message
The health of the entire human population, especially vulnerable people, might be negatively impacted by climate change and air pollution. This systematic review study implies that people with disabilities (PWDs) suffer more severe physical and mental health consequences from exposure to environmental challenges compared to non-disabled individuals.

Citations

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Duration-specific effects of extreme heat on mortality among people with disabilities in Korea: a nationwide population-based study
Kyung-Hwa Choi, Jonghyuk Choi, Ho-Jang Kwon, Mina Ha, Yoonhyeok Choi, Hyungryul Lim
Environmental Research.2026; 289: 123375. CrossRef
Differential relationships between physical activity and mental health among adults with disabilities in Korea
Shiva Raj Acharya
BMC Public Health.2026;[Epub] CrossRef
Leave no one behind: a call to include people with disabilities in climate change and health research
Sera Kim, Yejin Kim, Jinah Park, Ranyeong Kim, Whanhee Lee, Michelle L Bell, Jong-Tae Lee
The Lancet Planetary Health.2026; 10(3): 101440. CrossRef
Subjective well-being of people with disability in Tasmania: Exploring the role of neighborhood environments, socioeconomic, and housing circumstances
Maria Hobbs, Kim Jose, Ceridwen Owen, Verity Cleland
Journal of Urban Affairs.2026; : 1. CrossRef
Impacts of climate change on mental health and its underlying mechanisms: an umberella review
Arezoo Davariniamotlaghquchan, Zeinab Niazmand, Mohsen Shafiee, Abbas Ostadtaghizadeh
Annals of General Psychiatry.2026;[Epub] CrossRef
Association between ambient temperature and all-cause hospitalization by functional status in Japan: A time-stratified case-crossover study
Hana Takeuchi, Vera Ling Hui Phung, Yoshihisa Miyamoto, Shotaro Aso, Chris Fook Sheng Ng, Lei Yuan, Hideo Yasunaga, Masahiro Hashizume
Environmental Epidemiology.2026; 10(4): e510. CrossRef
Association between ozone and emergency department visits in people with disabilities in South Korea: a nationwide case-crossover study
Jinah Park, Ayoung Kim, Michelle L Bell, Ziyad Al-Aly, Kristi L Ebi, Sooyoung Kim, Seoyeong Ahn, Cinoo Kang, Ho Kim, Whanhee Lee
International Journal of Epidemiology.2026;[Epub] CrossRef
Mediation of Fine Particulate Matter on the Association Between Daily Temperature and Mortality
Dajeong Ham, Youn-Hee Lim, Soontae Kim, Ho-Jang Kwon, Sanghyuk Bae
Journal of Korean Medical Science.2025;[Epub] CrossRef
Ambient fine particulate matter and mortality risk among people with disability in Korea based on the National Health Insurance database: a retrospective cohort study
Jonghyuk Choi, Hyungryul Lim, Ho-Jang Kwon, Mina Ha, Soontae Kim, Kyung-Hwa Choi
BMC Public Health.2025;[Epub] CrossRef
Cardiometabolic Diseases and Mental Health Disorders in Korean Adults With Disabilities: A 3-Year Retrospective Analysis and Risk Comparison
Shiva Raj Acharya, NamKwen Kim, Navin Ray, Diwash Timilsina
American Journal of Preventive Medicine.2025; 69(3): 107938. CrossRef
Climate Change, Air Pollution and the Global Obesity Syndemic: a Review of Current Evidence
Natalia G. Vallianou, Dimitris C. Kounatidis, Eleni V. Geladari, Angelos Evangelopoulos, Vasileios Kaldis, Theodora Stratigou, Apostolos A. Evangelopoulos, Irene Karampela, Maria Dalamaga
Current Obesity Reports.2025;[Epub] CrossRef

Cohort Profile

Cohort profile: the Environmental-Pollution-Induced Neurological EFfects (EPINEF) study: a multicenter cohort study of Korean adults: Heeseon Jang, Woojin Kim, Jaelim Cho, Jungwoo Sohn, Juhwan Noh, Gayoung Seo, Seung-Koo Lee, Young Noh, Sung Soo Oh, Sang-Baek Koh, Hee Jin Kim, Sang Won Seo, Ho Hyun Kim, Jung Il Lee, Sun-Young Kim, Changsoo Kim; Epidemiol Health. 2021;43:e2021067. Published online September 16, 2021; DOI: https://doi.org/10.4178/epih.e2021067

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13 Web of Science
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Abstract Summary PDF Supplementary Material

Abstract

The general population is exposed to numerous environmental pollutants, and it remains unclear which pollutants affect the brain, accelerating brain aging and increasing the risk of dementia. The Environmental-Pollution-Induced Neurological Effects study is a multi-city prospective cohort study aiming to comprehensively investigate the effect of different environmental pollutants on brain structures, neuropsychological function, and the development of dementia in adults. The baseline data of 3,775 healthy elderly people were collected from August 2014 to March 2018. The eligibility criteria were age ≥50 years and no self-reported history of dementia, movement disorders, or stroke. The assessment included demographics and anthropometrics, laboratory test results, and individual levels of exposure to air pollution. A neuroimaging sub-cohort was also recruited with 1,022 participants during the same period, and brain magnetic resonance imaging and neuropsychological tests were conducted. The first follow-up environmental pollutant measurements will start in 2022 and the follow-up for the sub-cohort will be conducted every 3-4 years. We have found that subtle structural changes in the brain may be induced by exposure to airborne pollutants such as particulate matter 10 μm or less in diameter (PM10), particulate matter 2.5 μm or less in diameter (PM2.5) and Mn10, manganese in PM10; Mn2.5, manganese in PM2.5. PM10, PM2.5, and nitrogen dioxide in healthy adults. This study provides a basis for research involving large-scale, long-term neuroimaging assessments in community-based populations.

Summary

Korean summary
EPINEF 코호트는 환경유해인자에 의한 신경계 질환의 위해성을 평가하고, 환경유해인자로 유발되는 신경심리학적 기능 저하 또는 뇌 노화에 대한 근거를 제공하기 위해 2014년부터 50세 이상의 건강한 성인을 대상으로 시작되었습니다. 본 코호트는 뇌 영상학적 표지자와 인지 기능과 관련된 환경유해인자를 광범위하게 조사한 한국 최초의 장기 추적관찰 연구로, 대기 오염 물질 또는 다환방향족탄화수소 노출이 대뇌 영상표지자 및 신경심리학적 기능, 노인의 우울 증상에 대한 악화 요인으로서의 대기오염물질 노출과 결혼 상태의 교호작용 등의 연구결과들을 발표하였습니다. 또한, 추후에도 코호트의 지속적인 추적을 통해 환경유해인자 노출에 따른 신경학적 건강영향을 연구하여, 신경계 질환 관리를 위한 보건 정책 개선에 기여할 수 있을 것으로 기대됩니다.

Key Message
The EPINEF cohort was started in 2014 to assess the risk of neurological diseases caused by environmental harmful factors and to provide evidence for neuropsychological dysfunction or brain aging induced by these factors. This cohort is the first long-term follow-up study in Korea to extensively investigate brain imaging markers and environmental harmful factors related to cognitive function, and several related research results have been published. In addition, the follow-up survey will be continued in the future, and we expect that the results of the study will contribute to improving health policies for the management of neurological diseases.

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Commentary

Persistent Organic Pollutants and Obesity-Related Metabolic Dysfunction: Focusing on Type 2 Diabetes: Duk-Hee Lee; Epidemiol Health. 2012;34:e2012002. Published online January 27, 2012; DOI: https://doi.org/10.4178/epih/e2012002

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Abstract PDF

Abstract

Even though obesity is a well-established risk factor of type 2 diabetes, there is emerging evidence that persistent organic pollutants (POPs), a variety of lipophilic chemicals accumulated in adipose tissue, may be critically involved in the pathogenesis of type 2 diabetes. Among various POPs, serum concentrations of organochlorine pesticides and polychlorinated biphenyls (PCBs) were the most strongly and consistently linked to type 2 diabetes in both cross-sectional and prospective studies. In particular, obesity did not seem to be related to type 2 diabetes among persons with very low serum concentrations of POPs, suggesting a more fundamental role of chlorinated POPs in the pathogenesis of type 2 diabetes. These POPs were also associated with obesity, insulin resistance, and adverse lipid profiles like high triglyceride and low high-density lipoprotein (HDL) cholesterol among persons without diabetes, all metabolic dysfunctions commonly observed before developing type 2 diabetes. Recent animal studies supported the findings from epidemiological studies. If all these findings on POPs are true, it suggests that any effort to reduce the external and internal exposure to POPs would be necessary to decrease the social burden of type 2 diabetes.

Summary

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