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

OBJECTIVE: To determine the association of meteorological factors and air pollutants (MFAPs) with fracture and to estimate the effect size/time lag. DESIGN: This is a nationwide population-based ecological study from 2008 to 2017. SETTING: Eight large metropolitan areas in Korea. PARTICIPANTS: Of 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 (PM(2.5)), PM(10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide) were obtained from the Air Korea database. PRIMARY AND SECONDARY OUTCOME MEASURES: We 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. RESULTS: Overall, 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 PM(2.5)) showed significant association with fractures, with positive correlations at time lags 7, 5–7, 5–7, 3–7 and 6–7 days, respectively. CONCLUSIONS: Various MFAPs could affect the occurrence of fractures. The average temperature, daily rain, wind speed, daily snow and PM(2.5) were most closely associated with fracture. Thus, improved public awareness on these MFAPs is required for clinical prevention and management of fractures.