Research Article: Air pollution influences the incidence of otitis media in children: A national population-based study

Date Published: June 28, 2018

Publisher: Public Library of Science

Author(s): Mina Park, Jiyeon Han, Myoung-jin Jang, Myung-Whan Suh, Jun Ho Lee, Seung Ha Oh, Moo Kyun Park, Alexander Larcombe.


Otitis media (OM) is a major reason for children’s visits to physicians and a major cause of their being treated with antibiotics. It not only causes economic burdens but also influences hearing, speech, and education. To our knowledge, no nationwide population-based study has assessed the association between air pollution and OM. Therefore, this study evaluated the association between air pollution levels and the incidence of OM.

We identified cases of OM that occurred in South Korea between January 2011 and December 2012 from the Korea National Health Insurance Service-National Sample Cohort database, and evaluated its relationship with five air pollutants: particulate matter (PM10, particulates ≤10 μm in diameter), nitrogen dioxide (NO2), ozone (O3), sulfur dioxide, and carbon monoxide. Associations between the weekly incidence of OM and the five air pollutants were analyzed using generalized estimating equations. Conditional logistic regression analysis was used to obtain odds ratios (ORs) and their 99.9% Bonferroni-corrected confidence intervals after adjusting for gender, age, season, and region.

We based our analysis on 160,875 hospital visits for OM by children aged <15 years. Correlations with higher concentrations of the five pollutants showed higher ORs than did the reference values at most time lags. PM10 had the largest influence on the OM incidence at a time lag of 0 weeks, whereas NO2 and O3 had the largest impacts on OM incidence at time lags of 1 and 4 weeks, respectively. These findings support the notion that the incidence of OM is associated with ambient air pollution.

Partial Text

Otitis media (OM) is a major reason for children’s visits to physicians [1] and a major cause of their being treated with antibiotics [2]. Moreover, OM has effects on hearing, speech, and educational performance. The total economic burden of acute OM is estimated to be approximately $606 million per year in South Korea. Moreover, the average cost of admission for acute OM per person was about $1,690 per year, and that of outpatient visits was $199 per person [3].

By analyzing the incidence of OM over the whole of South Korea in 2011 and 2012, we showed a significant relationship between ambient air pollutants and the incidence of OM in children aged <15 years. Among the five pollutants analyzed, PM10, NO2, and O3 showed the greatest effects at time lags 0, 1, and 4, respectively. Higher SO2 and CO levels showed increased influence on OM compared with the lowest concentration quartiles. Above all, PM10 was most strongly associated with OM. PM10 concentrations ≥151 μg/m3 showed a significantly greater impact on OM compared with PM10 ≤30 μg/m3 at time lag 0 (OR = 1.34, 99.9% CI = 1.17–1.54).   Source:


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