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Hyemin Jang

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Open access Aug 2026

Extreme Heat Exposure and All-Cause Mortality in Chronic Kidney Disease: A Nationwide Time-Stratified Case-Crossover Study of More Than One Million Patients

Chronic kidney disease (CKD) imposes a global public health burden and is known to be affected by environmental stress. Although extreme heat exposure is a risk factor for CKD, the short-term heat effects in patients with CKD are unclear. We examined the association between ambient heat exposure and mortality in CKD patients. From the National Health Insurance Service (NHIS) data in Korea, we constructed a cohort of approximately 1.14 million CKD patients and a matched non-CKD cohort (1:1 matched on sex and 10-year age group). Within each cohort separately, all deaths during the follow-up period (2015–2023) were identified and analyzed using a time-stratified case-crossover design. Comparing the 99th percentile temperature (extreme heat) to the 75th percentile temperature (moderate heat), associations with all-cause mortality were estimated with distributed lag nonlinear models (DLNMs; lags 0–6) within conditional logistic regression. Subgroup and sensitivity analyses assessed effect modification and robustness. During follow-up, 223,949 and 178,878 deaths occurred in the CKD group and matched non-CKD group, respectively. Extreme heat was associated with increased mortality risk in the CKD group (OR 1.041; 95% CI 1.002–1.081; p = 0.041). Between-group analysis showed no significant effect modification by CKD status (relative OR 1.048; 95% CI 0.990–1.110; interaction p = 0.107). Subgroup analyses indicated significant differences among women, elderly individuals, non-Medical Aid recipients, and those with hypertension. Short-term extreme heat exposure is associated with increased mortality in patients with CKD, with heightened vulnerability in specific subgroups. These findings highlight the need for targeted preventive strategies in the CKD population.

Y. Roh, Jin Kyung Kwon, Seung Hyun Han et al. · Environment & Health · 0 citations

Open access Aug 2026

Long-term PM2.5 exposure and leukemia risk from childhood to early adulthood: A nationwide longitudinal cohort study with time-varying exposure analysis.

Long-term exposure to fine particulate matter (PM2.5) has been suggested as an environmental risk factor for childhood leukemia. This study examined the association between time-varying PM2.5 exposure and leukemia incidence in a nationwide cohort of Korean children and adolescents. We used data from the National Health Insurance Service-National Sample Cohort (2002-2020), including beneficiaries aged 0-18 years at enrollment who were followed until leukemia onset, death, or study end. Leukemia onset was defined as the first hospital visit with a primary diagnostic code from the 10th revision of the International Classification of Diseases. Annual PM2.5 concentrations were assigned to all 226 inland districts in South Korea using mean predictions from a machine learning-based ensemble model. Cox regression models with time-varying exposures and confounders were applied. Two-pollutant models incorporating NO2 and O3 were conducted as sensitivity analyses. Among 384,606 individuals aged 0-18 at enrollment, 272 developed leukemia during follow-up, including 83 who were diagnosed after the age of 18 years. The cohort's average annual PM2.5 concentration was 29.6 μg/m3 (standard deviation: 3.1). Each 5 μg/m3 increase in annual PM2.5 was associated with a hazard ratio of 1.40 (95% confidence interval: 1.04-1.90) for leukemia. The effect estimate remained comparable when follow-up was censored at age 18 years, suggesting that the findings were not materially influenced by the inclusion of diagnoses occurring after age 18. Long-term PM2.5 exposure was associated with increased leukemia incidence in this national cohort. These findings underscore the importance of reducing air pollution to protect the health of children and adolescents.

Y. Choi, Hyemin Jang, Whanhee Lee et al. · Environmental Research · 0 citations