The lag-effect pattern in the relationship of particulate air pollution to daily mortality in Seoul, Korea

To assess differences in the lag-effect pattern in the relationship between particulate matter less than 10 mum in aerodynamic diameter (PM10) and cause-specific mortality in Seoul, Korea, from January 1995 to December 1999, we performed a time-series analysis. We used a generalized additive Poisson regression model to control for time trends, temperature, humidity, air pressure, and the day of the week. The PM10 effect was estimated on the basis of the time-series models using the 24-h means and the quadratic distributed-lag models using a cumulative 6-day effect. One interquartile range increase in the 6-day cumulative mean of PM10 (43.12 mug/m(3)) was associated with an increase in non-accidental deaths [3.7%, 95% confidence interval (CI): 2.1, 5.4], respiratory disease (13.9%, 95% CI: 6.8, 21.5), cardiovascular disease (4.4%, 95% CI: -1.0, 9.0), and cerebrovascular disease (6.3%, 95% CI: 2.3, 10.5). We found the following patterns in the disease-specific lag-effect window: respiratory mortality was more affected by air pollution level on the day of death, whereas cardiovascular deaths were more affected by the previous day's air pollution level. Cerebrovascular deaths were simultaneously associated with the air pollution levels of the same day and the previous day. The patterns in the lag effect from the distributed-lag models were similar to those of a series of time-series models with 24-h means. These results contribute to our understanding of how exposure to air pollution causes adverse health effects.