Download This Paper
Preprints with The Lancet is a collaboration between The Lancet Group of journals and SSRN to facilitate the open sharing of preprints for early engagement, community comment, and collaboration. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early-stage research papers that have not been peer-reviewed. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. The findings should not be used for clinical or public health decision-making or presented without highlighting these facts. For more information, please see the FAQs.
Association between Long-Term PM 2·5 Exposure and Risk of Kawasaki Disease in Children: A Nationwide Longitudinal Cohort Study
21 Pages Posted: 31 May 2023
More...Abstract
Background: Based on previous studies suggesting air pollution as a potential risk factor for Kawasaki Disease (KD), we examined the association of long-term exposure to childhood fine particulate matter (PM2·5) with the risk of KD.
Methods: We used National Health Insurance Service–National Sample Cohort data from 2002 to 2019, which included beneficiaries aged 0 years at enrollment and followed‑up until the onset of KD or age 5 years. The onset of KD was defined as the first hospital visit record with a primary diagnostic code of M30.3, based on the 10th revision of the International Classification of Diseases, and with an intravenous immunoglobulin (IVIG) prescription. We assigned PM2·5 concentrations to 226 districts, based on mean annual predictions from a machine learning-based ensemble prediction model. We performed Cox proportional-hazards modeling with time-varying exposures and confounders.
Findings: We identified 134 634 individuals aged five or less at enrollment and, of these, 1220 individuals who had a KD onset and an IVIG prescription during study period. The average annual concentration of PM2·5 exposed to the entire cohort was 28·2 μg/m³ (SD 2·9). For each 5 μg/m³ increase in annual PM2·5 concentration, the hazard ratio of KD was 1·21 (95% CI 1·05–1·39).
Interpretation: In this nationwide, population-based, cohort study, long-term childhood exposure to PM2·5 was associated with an increased incidence of KD in children. The study highlights plausible mechanisms for the association between PM2·5 and KD, but further studies are needed to confirm our findings.
Funding: None.
Declaration of Interest: The authors declare that they have no known competing financial interests that could have influenced the work reported in this paper.
Ethical Approval: The Institutional Review Board of the Ewha Womans University Seoul Hospital (IRB number: SEUMC 2022-05-034) approved the study. The requirement for informed patient consent was waived because the NHIS–NSC database is anonymized according to strict confidentiality guidelines.
Keywords: Children's environmental health, Fine particulate matter, Kawasaki disease, Long term exposure
Suggested Citation: Suggested Citation