Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2020; 26(39): 6074-6086
Published online Oct 21, 2020. doi: 10.3748/wjg.v26.i39.6074
Relationship of meteorological factors and air pollutants with medical care utilization for gastroesophageal reflux disease in urban area
Ho Seok Seo, Jinwook Hong, Jaehun Jung
Ho Seok Seo, Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Jinwook Hong, Jaehun Jung, Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine and Science, Incheon 21565, South Korea
Jaehun Jung, Department of Preventive Medicine, Gachon University College of Medicine, Incheon 21565, South Korea
Author contributions: Jung J designed the study and participated in the data acquisition; Hong J did data analysis and interpretation; Seo HS drafted the manuscript; all approved final manuscript.
Supported by Gachon University Gil Medical Center, No. FRD2018-17 and No. FRD2019-11.
Institutional review board statement: This study was approved by the Institutional Review Board of the Gachon University Gil Medical Center, which waived the need for informed consent, No. GCIRB2019-039.
Informed consent statement: Owing to the retrospective nature of this study, patients and the public were not involved in the study design, data collection, analysis, or interpretation of data.
Conflict-of-interest statement: Authors have no conflicts of interest or financial ties to disclose.
Data sharing statement: The datasets generated for and/or analyzed in the current study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jaehun Jung, MD, PhD, Assistant Professor, Department of Preventive Medicine, Gachon University College of Medicine, 38-13, Dokjeom-ro, Incheon 21565, South Korea. eastside1st@gmail.com
Received: July 19, 2020
Peer-review started: July 19, 2020
First decision: August 8, 2020
Revised: August 19, 2020
Accepted: September 16, 2020
Article in press: September 16, 2020
Published online: October 21, 2020

Gastroesophageal reflux disease (GERD) is a highly prevalent disease of the upper gastrointestinal tract, and it is associated with environmental and lifestyle habits. Due to an increasing interest in the environment, several groups are studying the effects of meteorological factors and air pollutants (MFAPs) on disease development.


To identify MFAPs effect on GERD-related medical utilization.


Data on GERD-related medical utilization from 2002 to 2017 were obtained from the National Health Insurance Service of Korea, while those on MFAPs were obtained from eight metropolitan areas and merged. In total, 20071900 instances of GERD-related medical utilizations were identified, and 200000 MFAPs were randomly selected from the eight metropolitan areas. Data were analyzed using a multivariable generalized additive Poisson regression model to control for time trends, seasonality, and day of the week.


Five MFAPs were selected for the prediction model. GERD-related medical utilization increased with the levels of particulate matter with a diameter ≤ 2.5 μm (PM2.5) and carbon monoxide (CO). S-shaped and inverted U-shaped changes were observed in average temperature and air pollutants, respectively. The time lag of each variable was significant around nine days after exposure.


Using five MFAPs, the final model significantly predicted GERD-related medical utilization. In particular, PM2.5 and CO were identified as risk or aggravating factors for GERD.

Keywords: Gastroesophageal reflux disease, Air pollution, Meteorological factor, Particulate matter, Carbon monoxide

Core Tip: The model showed correlation between five meteorological factors and air pollutants and gastroesophageal reflux disease (GERD)-related medical utilization. S- and inverted U-shaped changes were noted in average temperature and air pollutants. Average temperature, sunshine duration, wind speed, PM2.5, and carbon monoxide are risk factors of GERD. GERD occurrence is reduced using environmental management and national alarm systems.