Premature Deaths Attributable to Long-term Exposure to Ambient Fine Particulate Matter in the Republic of Korea

Background: Ambient fine particulate matter (PM 2.5 ) is the major environmental health risk factor in Korea. Exposure to PM 2.5 has been a growing public concern nationwide. With the rapid aging of the Korean population, the health effects attributable to long-term exposure to PM 2.5 were expected to increase further in the future. We aimed to estimate premature deaths attributable to long-term exposure to ambient PM 2.5 in Korea. Methods: A modelled estimation of long-term exposure to PM 2.5 was used to calculate the nationwide exposure level. Hazard ratios of long-term exposure to PM 2.5 were obtained from a large prospective cohort study in North America. Modified cause of death (CoD) data, which applied the garbage code reclassification algorithm, were used to calculate premature deaths attributable to long-term exposure to PM 2.5 . Results: From 1990 to 2013, the average population-weighted PM 2.5 concentration in Korea was 30.2 g/m 3 . The estimated number of premature deaths was 17,203 (95% confidence interval [CI], 11,056-22,772). The most common CoD was ischemic stroke (5,382; 3,101-7,403), followed by cancer of trachea, bronchus, and lung (4,958; 2,857-6,820), hemorrhagic stroke (3,452; 1,989-4,748), and ischemic heart disease (3,432; 1,383-5,358). Conclusion: Premature deaths due to long-term exposure to PM 2.5 accounted for 6.4% of all deaths in Korea. However, individual efforts alone cannot prevent the effects of air pollution. This disease burden study can serve as a basis for the establishment of government policies and budgets and can be used to assess the effectiveness of environmental health policies.