Relative risk for spontaneous pneumothorax hospital visits per interquartile range increase in air pollutants (NO2, SO2,O3,CO, PM2.5, PM10, and PM10-2.5)a exposure from lag day 0 to 4

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Supplemental Digital Content

Association between ambient air pollution exposure and spontaneous pneumothorax occurrence

Changwoo Han^a, Youn-Hee Lim^b,c, Kweon Jung^d, Yun-Chul Hong^a,b,c

a Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea

b Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Korea

c Environmental Health Center, Seoul National University College of Medicine, Seoul, Korea

d Seoul Metropolitan Institute of Public Health and Environment, Seoul, Korea

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2 eTable 1. Number of eligible study participants (2007-2010)

Year Number of study participants

2007 106,009

2008 104,344

2009 103,429

2010 101,098

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eTable 2. Relative risk for spontaneous pneumothorax hospital visits per interquartile range increase in air pollutants (NO2, SO2,O3,CO, PM2.5, PM10, and PM10-2.5)^a exposure from lag day 0 to 4. Results of single-pollutant model adjusted for daily mean temperature, relative humidity,time, day of the week and first day of month.

Single pollutant model NO2 SO2 O3 CO PM2.5 PM10 PM10-2.5

Main analysis, Define consecutive medical service usage below 30 days as single episode of disease events (516 spontaneous pneumothorax hospital visits)

Lag 0 1.00 (0.88-1.14) 1.04 (0.93-1.16) 0.93 (0.79-1.10) 1.05 (0.95-1.17) 1.03 (0.93-1.13) 0.99 (0.90-1.08) 0.97 (0.89-1.05) Lag 1 1.11 (0.97-1.26) 1.10 (0.99-1.22) 0.90 (0.76-1.06) 1.11 (1.01-1.23) 1.10 (1.01-1.21) 1.09 (1.01-1.18) 1.06 (1.00-1.12) Lag 2 1.15 (1.01-1.32) 1.07 (0.96-1.20) 0.91 (0.77-1.07) 1.09 (0.99-1.21) 1.06 (0.97-1.17) 1.10 (1.02-1.18) 1.07 (1.02-1.13) Lag 3 1.03 (0.90-1.19) 1.01 (0.90-1.13) 1.03 (0.87-1.22) 1.01 (0.90-1.13) 0.97 (0.88-1.08) 1.01 (0.93-1.10) 1.02 (0.96-1.09) Lag 4 0.91 (0.80-1.04) 0.93 (0.82-1.04) 0.95 (0.80-1.12) 0.93 (0.83-1.04) 0.92 (0.83-1.02) 0.94 (0.85-1.03) 0.96 (0.89-1.04) Define consecutive medical service usage below 20 days as single episode of disease events (577 spontaneous pneumothorax hospital visits)

Lag 0 0.98 (0.87-1.11) 1.03 (0.93-1.14) 0.95 (0.81-1.11) 1.05 (0.95-1.16) 1.02 (0.93-1.12) 1.00 (0.91-1.08) 0.98 (0.91-1.06) Lag 1 1.07 (0.94-1.20) 1.07 (0.97-1.18) 0.89 (0.76-1.04) 1.08 (0.99-1.19) 1.07 (0.98-1.17) 1.08 (1.00-1.16) 1.05 (1.00-1.11) Lag 2 1.12 (0.99-1.27) 1.06 (0.95-1.18) 0.87 (0.74-1.02) 1.06 (0.96-1.17) 1.04 (0.95-1.14) 1.09 (1.01-1.17) 1.07 (1.02-1.13) Lag 3 1.01 (0.89-1.16) 0.99 (0.88-1.10) 1.00 (0.85-1.17) 0.99 (0.89-1.10) 0.96 (0.87-1.06) 1.00 (0.92-1.09) 1.02 (0.96-1.08) Lag 4 0.89 (0.78-1.02) 0.92 (0.82-1.03) 0.93 (0.80-1.09) 0.91 (0.82-1.02) 0.93 (0.85-1.03) 0.94 (0.86-1.02) 0.96 (0.89-1.03) Define consecutive medical service usage below 90 days as single episode of disease events (418 spontaneous pneumothorax hospital visits)

Lag 0 1.02 (0.88-1.17) 1.01 (0.89-1.14) 0.84 (0.70-1.02) 1.03 (0.92-1.16) 1.00 (0.90-1.11) 0.96 (0.86-1.06) 0.94 (0.86-1.04) Lag 1 1.12 (0.97-1.29) 1.08 (0.96-1.21) 0.83 (0.69-0.99) 1.11 (0.99-1.24) 1.08 (0.98-1.20) 1.08 (0.99-1.17) 1.05 (0.99-1.12) Lag 2 1.12 (0.97-1.28) 1.07 (0.95-1.20) 0.92 (0.77-1.11) 1.09 (0.97-1.21) 1.07 (0.96-1.18) 1.11 (1.03-1.21) 1.09 (1.03-1.15) Lag 3 1.01 (0.87-1.17) 1.04 (0.92-1.18) 1.00 (0.83-1.19) 1.04 (0.92-1.17) 1.00 (0.90-1.12) 1.04 (0.95-1.13) 1.03 (0.97-1.10)

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Lag 4 0.94 (0.81-1.09) 0.96 (0.84-1.09) 0.96 (0.80-1.15) 0.95 (0.84-1.07) 0.95 (0.85-1.06) 0.96 (0.87-1.07) 0.98 (0.90-1.06) Analysis with both men and women spontaneous pneumothorax hospital visit cases (583 spontaneous pneumothorax hospital visits)

Lag 0 0.98 (0.87-1.11) 1.01 (0.91-1.12) 0.93 (0.80-1.09) 1.05 (0.95-1.15) 1.00 (0.92-1.10) 0.97 (0.89-1.05) 0.95 (0.88-1.03) Lag 1 1.06 (0.94-1.20) 1.06 (0.96-1.18) 0.93 (0.79-1.08) 1.09 (0.99-1.19) 1.07 (0.98-1.17) 1.06 (0.99-1.14) 1.04 (0.98-1.10) Lag 2 1.12 (0.99-1.28) 1.05 (0.95-1.16) 0.90 (0.77-1.05) 1.07 (0.97-1.17) 1.05 (0.96-1.15) 1.08 (1.00-1.16) 1.06 (1.01-1.12) Lag 3 1.02 (0.90-1.17) 0.99 (0.88-1.10) 1.03 (0.88-1.20) 0.99 (0.89-1.10) 0.97 (0.88-1.07) 1.01 (0.93-1.09) 1.02 (0.96-1.08) Lag 4 0.92 (0.81-1.05) 0.93 (0.83-1.04) 0.94 (0.81-1.09) 0.95 (0.85-1.05) 0.93 (0.84-1.02) 0.93 (0.86-1.02) 0.95 (0.89-1.03)

a NO2, Nitrogen dioxide; SO2, Sulfur dioxide; CO, Carbon monoxide; O3, Ozone; PM2.5, Particulate matter less than 2.5μm in diameter; PM10, Particulate matter less than 10μm in diameter; PM10-2.5, coarse particulate matter calculated by subtracting the daily mean concentrations of PM2.5 from those of PM10.

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eFigure 1. The location of the monitoring stations

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eFigure 2. Relative risk for spontaneous pneumothorax hospital visits per interquartile range increase in cumulative lag exposure of size fractionized particulate matter (0, 0-1, 0-2, 0-3, and 0-4 days). The model was adjusted for daily mean temperature, relative humidity, SO2, NO2, CO, O3, time, day of the week, and first day of month.

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eFigure 3. Lag response curve for IQR increase in PM2.5, PM10, and PM10-2.5 and spontaneous pneumothorax hospital visits. The model was adjusted for daily mean temperature, relative humidity, SO2, NO2, CO, O3,

time, day of the week, and first day of month.

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eFigure 4. Relative risk for spontaneous pneumothorax hospital visits per interquartile range increase in atmospheric pressure. The model was adjusted for PM, daily mean temperature, relative humidity, SO2, NO2, CO, O3, time, day of the week, and first day of month. (White circle: PM2.5; Black circle: PM10; White triangle: PM10- 2.5)

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eFigure 5. Relative risk for spontaneous pneumothorax hospital visits per mass increase in particulate matter from lag 0 to 4. The model was adjusted for daily mean temperature, relative humidity, SO2, NO2, CO, O3, time, day of the week, and first day of month