先前的大数据研究已广泛报道，接触细颗粒物（PM2.5）与全因死亡率相关；然而，这些研究大多数采用了生态时间序列设计，或者纳入了有限的研究区域或居住在监测良好的城市地区的个人。然而，包括不同年龄组特定原因死亡率的全国性队列研究很少。因此，本研究利用全国队列研究了韩国 PM2.5 与特定原因死亡率之间的关联。该纵向队列包含 2002 年至 2019 年间登记的 187,917 名国民健康保险服务国家样本队列参与者，年龄为 50-79 岁被使用了。年平均 PM2.5 是从基于机器学习的集成模型（测试 R2 = 0.87）中收集的，作为暴露值。我们采用时变 Cox 回归模型来检验长期 PM2.5 暴露与死亡率之间的关联。为了减少潜在的估计偏差，我们采用了广义倾向评分加权法。在糖尿病相关死亡率中，与长期 PM2.5（2 年移动平均值）的相关性很显着[风险比 (HR)：1.03 (95%) CI: 1.01, 1.06)]、循环系统疾病 [HR: 1.02 (95% CI: 1.00, 1.03)] 和癌症 [HR: 1.01 (95% CI: 1.00, 1.02)]。同时，循环系统相关的死亡率与较长的 PM2.5 暴露时间（1 或 2 年滞后）相关，而呼吸系统相关的死亡率与当年的 PM2.5 暴露相关。此外，50-64 岁人群与 PM2.5 的关联性比 65-79 岁人群更为明显，尤其是与心力衰竭相关的死亡。这项研究提出了这样的假设：长期暴露于 PM2.5与死亡率相关，并且这种关联可能因死亡原因而异。我们的结果突出了一个新的弱势群体：具有心力衰竭相关风险因素的中年人群。© 作者 2024；版权所有。由牛津大学出版社代表国际流行病学协会出版。

Previous studies with large data have been widely reported that exposure to fine particulate matter (PM2.5) is associated with all-cause mortality; however, most of these studies adopted ecological time-series designs or have included limited study areas or individuals residing in well-monitored urban areas. However, nationwide cohort studies including cause-specific mortalities with different age groups were sparse. Therefore, this study examined the association between PM2.5 and cause-specific mortality in South Korea using the nationwide cohort.A longitudinal cohort with 187 917 National Health Insurance Service-National Sample Cohort participants aged 50-79 years in enrolment between 2002 and 2019 was used. Annual average PM2.5 was collected from a machine learning-based ensemble model (a test R2 = 0.87) as an exposure. We performed a time-varying Cox regression model to examine the association between long-term PM2.5 exposure and mortality. To reduce the potential estimation bias, we adopted generalized propensity score weighting method.The association with long-term PM2.5 (2-year moving average) was prominent in mortalities related to diabetes mellitus [hazard ratio (HR): 1.03 (95% CI: 1.01, 1.06)], circulatory diseases [HR: 1.02 (95% CI: 1.00, 1.03)] and cancer [HR: 1.01 (95% CI: 1.00, 1.02)]. Meanwhile, circulatory-related mortalities were associated with a longer PM2.5 exposure period (1 or 2-year lags), whereas respiratory-related mortalities were associated with current-year PM2.5 exposure. In addition, the association with PM2.5 was more evident in people aged 50-64 years than in people aged 65-79 years, especially in heart failure-related deaths.This study identified the hypothesis that long-term exposure to PM2.5 is associated with mortality, and the association might be different by causes of death. Our result highlights a novel vulnerable population: the middle-aged population with risk factors related to heart failure.© The Author(s) 2024; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.