Association of meteorological factors and atmospheric particulate matter with the incidence of pneumonia: an ecological study

Abstract

Objectives: Inconsistent results have been found between pneumonia and meteorological factors. We aimed to identify principal meteorological factors associated with pneumonia, and to estimate the effect size and lag time. Methods: This was nationwide population-based study used a healthcare claims database merged with a weather database in eight metropolitan cities in Korea. We applied a stepwise approach using the Granger causality test and generalized additive model to elucidate the association between weekly pneumonia incidence (WPI) and meteorological factors/air pollutants (MFAP). Impulse response function was used to examine the time lag. Results: In total, 2 011 424 cases of pneumonia were identified from 2007 to 2017. Among MFAP, diurnal temperature range (DTR), humidity and particulate matter ≤2.5 μm in diameter (PM2.5) showed statistically significant associations with WPI (p < 0.001 for all 3 MFAPs). The association of DTR and WPI showed an inverted U pattern for bacterial and unspecified pneumonia, whereas for viral pneumonia, WPI increased gradually in a more linear manner with DTR and no substantial decline. Humidity showed a consistent pattern in all three pneumonia categories. WPI steeply increased up to 10 to 20 μg/m³ of PM2.5 but did not show a further increase in higher concentrations. On the basis of the result, we examined the effect of MFAP in different lag times up to 3 weeks. Conclusions: DTR, humidity and PM2.5 were identified as MFAP most closely associated with WPI. With the model, we were able to visualize the effect–time association of MFAP and WPI. © 2020 European Society of Clinical Microbiology and Infectious Diseases