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Original research
Effect of meteorological factors and air pollutants on out-of-hospital cardiac arrests: a time series analysis
  1. Jin-Ho Kim1,
  2. Jinwook Hong2,3,
  3. Jaehun Jung2,3,
  4. Jeong-Soo Im2
  1. 1Division of Cardiology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Gyeonggi-do, the Republic of Korea
  2. 2Department of Preventive Medicine, Gachon University College of Medicine, Incheon, the Republic of Korea
  3. 3Artificial Intelligence and Big-data Convergence Center, Gil Medical Center, Incheon, the Republic of Korea
  1. Correspondence to Dr Jeong-Soo Im, College of Medicine, Gachon University, Seongnam, the Republic of Korea; mdjsim{at}; Professor Jaehun Jung, Department of Preventive Medicine, Gachon University College of Medicine, Incheon, the Republic of Korea; eastside1st{at}


Objectives We aimed to investigate the effects of meteorological factors and air pollutants on out-of-hospital cardiac arrest (OHCA) according to seasonal variations because the roles of these factors remain controversial to date.

Methods A total of 38 928 OHCAs of cardiac origin that occurred within eight metropolitan areas between 2012 and 2016 were identified from the Korean nationwide emergency medical service database. A time series multilevel approach based on Poisson analysis following a Granger causality test was used to analyse the influence of air pollution and 13 meteorological variables on OHCA occurrence.

Results Particulate matter (PM) ≤2.5 µm (PM2.5), average temperature, daily temperature range and humidity were significantly associated with a higher daily OHCA risk (PM2.5: 1.59%; 95% CI: 1.51% to 1.66% per 10µg/m3, average temperature 0.73%, 95% CI: 0.63% to 0.84% per 1°C, daily temperature range: 1.05%, 95% CI: 0.63% to 1.48% per 1°C, humidity −0.48, 95% CI: −0.40 to −0.56 per 1%) on lag day 1. In terms of the impact of these four risk factors in different seasons, average temperature and daily temperature range were highly associated with OHCA in the summer and winter, respectively. However, only PM2.5 elevation (to varying extents) was an independent and consistent OHCA risk factor irrespective of the season.

Conclusions PM2.5, average temperature, daily temperature range and humidity were independently associated with OHCA occurrence in a season-dependent manner. Importantly, PM2.5 was the only independent risk factor for OHCA occurrence irrespective of seasonal changes.

  • cardiac arrest
  • epidemiology
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  • J-HK and JH contributed equally.

  • Contributors Design of the work: JJ, JI. Data acquisition: JI. Data analysis and interpretation: JH. Drafing the work: J-HK, JJ, JH. Final approval: all.

  • Funding This study was supported by grants from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Korea (Grant number: HI14C1135); and the Gachon University Gil Medical Center (Grant number: 2018-17).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Institutional Review Board of the Gachon University Gil Medical Center, which provided a waiver of consent (IRB No. GFIRB2019-313).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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