Ambient Fine Particulate Matter and Mortality Risk among People with Disability in Korea Based on the National Health Insurance Database: A Retrospective Cohort Study

Abstract

Background People with disabilities (PWD) may be more vulnerable to the adverse health effects of air pollution than the general population. This study examined the association between long-term exposure to ambient fine particulate matter (PM_2.5) and mortality risk in PWD considering disability type and severity. Methods Data from the Korean National Health Insurance Service and Statistics Korea were analyzed in this retrospective cohort study, including 2,880,265 individuals (41,501,709 person-years), of which 176,410 were PWD (2,011,231 person-years). PM_2.5 exposure was estimated using simulated data from 2006 to 2019. Causes of death included all causes, non-accidental causes, respiratory disease, lung cancer, and cardiovascular disease. Cox proportional hazard models were used to estimate hazard ratios (HRs) for mortality associated with PM_2.5 stratified by disability type and severity. Results PWD, particularly those with severe disabilities or specific impairments such as kidney problems or brain lesions, showed significantly high mortality risks from all causes, non-accidental causes, and cardiovascular diseases due to PM_2.5 exposure. For individuals with kidney impairment, the HR (95% confidence interval) for mortality on increasing PM_2.5 by 10 µg/m³ was 1.79 (1.27–2.52) from all causes, while for those with brain lesions, it was 1.10 (1.00–1.22) from cardiovascular disease. PWD were not susceptible to mortality from respiratory causes. Conclusions This study highlights the increased vulnerability of PWD, especially those with severe disabilities or specific impairments, to the adverse effects of PM_2.5 exposure. Targeted interventions tailored to disability type and severity, along with stricter air quality standards and specialized healthcare approaches, are needed.