Effect of meteorological factors and air pollutants on fractures: a nationwide population-based ecological study

Abstract

ObjectiveTo determine the association of meteorological factors and air pollutants (MFAPs) with fracture and to estimate the effect size/time lag.DesignThis is a nationwide population-based ecological study from 2008 to 2017.SettingEight large metropolitan areas in Korea.ParticipantsOf 8 093 820 patients with fractures reported in the Korea National Health Insurance database, 2 129 955 were analysed after the data set containing patient data (age, sex and site of fractures) were merged with MFAPs. Data on meteorological factors were obtained from the National Climate Data Center of the Korea Meteorological Administration. Additionally, data on air pollutants (atmospheric particulate matter ≤2.5 µm in diameter (PM2.5), PM10, ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide) were obtained from the Air Korea database.Primary and secondary outcome measuresWe hypothesised that there would be an association between MFAPs and the incidence of fracture. A generalised additive model was used while factoring in the non-linear relationship between MFAPs and fractures as well as a time lag ≤7 days. Multivariate analysis was performed. Backward elimination with an Akaike information criterion was used to fit the multivariate model.ResultsOverall, in eight urban areas, 2 129 955 patients with fractures were finally analysed. These included 370 344, 187 370, 173 100, 140 358, 246 775, 6501, 228 346, 57 183 and 719 978 patients with hip, knee, shoulder, elbow, wrist, hand, ankle, foot and spine fractures, respectively. Various MFAPs (average temperature, daily rain, wind speed, daily snow and PM2.5) showed significant association with fractures, with positive correlations at time lags 7, 5–7, 5–7, 3–7 and 6–7 days, respectively.ConclusionsVarious MFAPs could affect the occurrence of fractures. The average temperature, daily rain, wind speed, daily snow and PM2.5 were most closely associated with fracture. Thus, improved public awareness on these MFAPs is required for clinical prevention and management of fractures.

Recent advances in the identification of related factors and preventive strategies of hip fracture

“…Different MFAPs (average temperature, day rainfall, wind speed, daily snowfall, and particulate matter 2.5) are positively correlated with the risks of falling and hip fracture. Therefore, it is necessary to focus on the protection of the environment and strengthen the public's cognition of MFAPs to reduce the occurrence of hip fractures ( 123 ). It is also important to identify high-risk groups that are prone to falls and have an increased risk of hip fracture, such as older adults, women, patients with a history of falls, lower limb dysfunction, neuromuscular injuries, less physical activity, visual impairment, stroke, neurodegenerative diseases (Parkinson's and Alzheimer's disease), and mental disorders (depression) ( 124 , 125 ).…”

Study Investigates Impact of Meteorologic Conditions and Air Pollution on Fracture Occurrence

“…In a novel study, South Korean researchers report that the meteorologic conditions and air pollution (MFAPs) factors of average temperature, daily rain, wind speed, daily snow, and atmospheric particulate matter 2.5 μm or less in diameter (PM 2.5 ) were most closely associated with an increased occurrence of fractures. (See Kang et al, 2021. )…”