J Korean Med Sci.  2024 Aug;39(30):e218. 10.3346/jkms.2024.39.e218.

Estimation of Attributable Risk and Direct Medical and Non-Medical Costs of Major Mental Disorders Associated With Air Pollution Exposures Among Children and Adolescents in the Republic of Korea, 2011–2019

• Ha YW
• Kim TH
• Kang DR
• Park KS
• Shin DC
• Cho J
• Kim C

• KMID: 2558518
• DOI: http://doi.org/10.3346/jkms.2024.39.e218

Abstract

Background
Recent studies have reported the burden of attention deficit hyperactivity disorder [ADHD], autism spectrum disorder [ASD], and depressive disorder. Also, there is mounting evidence on the effects of environmental factors, such as ambient air pollution, on these disorders among children and adolescents. However, few studies have evaluated the burden of mental disorders attributable to air pollution exposure in children and adolescents.
Methods
We estimated the risk ratios of major mental disorders (ADHD, ASD, and depressive disorder) associated with air pollutants among children and adolescents using time-series data (2011–2019) obtained from a nationwide air pollution monitoring network and healthcare utilization claims data in the Republic of Korea. Based on the estimated risk ratios, we determined the population attributable fraction (PAF) and calculated the medical costs of major mental disorders attributable to air pollution.
Results
A total of 33,598 patients were diagnosed with major mental disorders during 9 years. The PAFs for all the major mental disorders were estimated at 6.9% (particulate matter < 10 μm [PM₁₀ ]), 3.7% (PM_2.5 ), and 2.2% (sulfur dioxide [SO₂ ]). The PAF of PM₁₀ was highest for depressive disorder (9.2%), followed by ASD (8.4%) and ADHD (5.2%). The direct medical costs of all major mental disorders attributable to PM₁₀ and SO₂ decreased during the study period.
Conclusion
This study assessed the burden of major mental disorders attributable to air pollution exposure in children and adolescents. We found that PM₁₀, PM_2.5 , and SO₂ attributed 7%, 4%, and 2% respectively, to the risk of major mental disorders among children and adolescents.

Keyword

Air Pollution; PM₁₀; PM_2.5; SO₂; Mental Disorders; Burden; Children; Adolescents

Figure

• 

  Fig. 1 Risk ratio (95% CI) of major mental disorders associated with air pollutants in different lag models. All models were adjusted for temperature, relative humidity, date, day of the week, holiday, and population of the region. (A) PM10 (per 10 μg/m3), (B) PM2.5 (per 10 μg/m3), (C) NO2 (per 1 ppb), (D) SO2 (per 1 ppb), (E) O3 (per 1 ppb), (F) CO (per 1 ppb).CI = confidence interval, PM10 = particulate matter < 10 μm, PM2.5 = particulate matter < 2.5 μm in aerodynamic diameter, NO2 = nitrogen dioxide, SO2 = sulfur dioxide, O3 = ozone, CO = carbon monoxide.

• 

  Fig. 2 Trends of population attributable fraction (%) of specific mental disorders due to PM10, PM2.5, and SO2. (A) Trends of population attributable fraction (%) of total mental disorders due to PM10, PM2.5, and SO2. (B) Trends of population attributable fraction (%) of attention deficit and hyperactivity disorder due to PM10 and PM2.5 by specific disorders. (C) Trends of population attributable fraction (%) of autism spectrum disorders due to PM10 and SO2. (D) Trends of population attributable fraction (%) of depressive desorder due to PM10 and PM2.5.PM10 = particulate matter < 10 μm, PM2.5 = particulate matter < 2.5 μm in aerodynamic diameter, SO2 = sulfur dioxide.

• 

  Fig. 3 Trends of attributable costs of specific mental disorders due to PM10, PM2.5, and SO2. (A) Trends of attributable total direct costs of total mental disorders due to PM10, PM2.5, and SO2 (unit: 1,000$). (B) Trends of attributable total direct costs of attention deficit and hyperactivity disorder due to PM10 and PM2.5 by specific disorders (unit: 1,000$). (C) Trends of attributable total direct costs of autism spectrum disorders due to PM10 and SO2 (unit: 1,000$). (D) Trends of attributable total direct costs of depressive disorder due to PM10 and PM2.5 (unit: 1,000$).PM10 = particulate matter < 10 μm, PM2.5 = particulate matter < 2.5 μm in aerodynamic diameter, SO2 = sulfur dioxide.

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