{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T02:08:51Z","timestamp":1783908531910,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","award":["RS\u20102025\u201002263702"],"award-info":[{"award-number":["RS\u20102025\u201002263702"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2018R1A5A1060031"],"award-info":[{"award-number":["2018R1A5A1060031"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Although the association between air pollutants and chronic rhinitis has been extensively investigated, causal inference is lacking. We aimed to investigate the causal relationship between air quality index (AQI) and outpatient visits for chronic rhinitis using instrumental variable (IV) analysis, employing thermal inversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used National Health Insurance Service data collected between January 1, 2014, and December 31, 2017, to determine the short\u2010term causal relationship between air pollution and outpatient visits due to chronic rhinitis. A two\u2010stage generalized method\u2010of\u2010moments Poisson regression model was employed to estimate the causal effects. Stratified analyses by age group and robustness tests for IV with negative controls were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 81,210,447 outpatient visits for chronic rhinitis were analyzed. IV analysis demonstrated significant positive associations between AQI and outpatient visits on lag days 0, 3, 5, and 6, with the strongest effect observed at Lag 0 (relative risk [RR] 1.078, 95% confidence interval [CI] 1.045\u20131.113). Stratified analysis revealed that individuals aged 10\u201319\u2009years were the most vulnerable, showing statistically significant relative risks across all lag days (RR: 1.039\u20131.161). Analyses using negative control outcomes and exposures supported the validity of the proposed instrumental variable approach, suggesting a robust causal effect of AQI on outpatient visits for chronic rhinitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We identified a causal relationship between increased air pollution and outpatient visits for chronic rhinitis. Unlike a simple association potentially confounded by various factors, our analysis provides robust evidence of the causal impact of air pollution on disease burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70445","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T08:11:20Z","timestamp":1772957480000},"page":"3373-3380","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Causal Effect of Air Pollution on Outpatient Visits for Chronic Rhinitis"],"prefix":"10.1002","volume":"136","author":[{"given":"Su Hwan","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Information Statistics Gyeongsang National University  Jinju Gyeongsangnamdo Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong Pyo","family":"Kim","sequence":"additional","affiliation":[{"name":"Interdisciplinary Program of Medical Informatics Seoul National University College of Medicine  Seoul South Korea"},{"name":"Integrated Major in Innovative Medical Science Seoul National University Graduate School  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zio","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Seoul National University College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heung\u2010Woo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Seoul National University College of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2687-6919","authenticated-orcid":false,"given":"Jin Youp","family":"Kim","sequence":"additional","affiliation":[{"name":"Interdisciplinary Program of Medical Informatics Seoul National University College of Medicine  Seoul South Korea"},{"name":"Department of Otorhinolaryngology\u2010Head and Neck Surgery, Ilsan Hospital Dongguk University  Goyang Gyeonggi South Korea"},{"name":"Sensory Organ Research Institute, College of Medicine Dongguk University  Gyeongju South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4432-4894","authenticated-orcid":false,"given":"Hyung\u2010Jin","family":"Yoon","sequence":"additional","affiliation":[{"name":"Interdisciplinary Program of Medical Informatics Seoul National University College of Medicine  Seoul South Korea"},{"name":"Integrated Major in Innovative Medical Science Seoul National University Graduate School  Seoul Korea"},{"name":"Department of Biomedical Engineering Seoul National University College of Medicine  Seoul Korea"},{"name":"Medical Bigdata Research Center Seoul National University College of Medicine  Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2222.2011.03891.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2007.01620.x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1081-1206(10)62603-8"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/falgy.2024.1387525"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.18787\/jr.2024.00015"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2019.11.040"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.18787\/jr.2024.00021"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.18787\/jr.2024.00022"},{"key":"e_1_2_10_10_1","first-page":"1012","article-title":"Association Between Ambient Air Pollution and Allergic Rhinitis: A Systematic Review and Meta\u2010Analysis","volume":"134","author":"Zhang Y.","year":"2024","journal-title":"Laryngoscope"},{"key":"e_1_2_10_11_1","first-page":"31","article-title":"Ambient Air Pollution and the Risk of Chronic Rhinosinusitis: A Systematic Review and Meta\u2010Analysis","volume":"134","author":"Gao W.","year":"2024","journal-title":"Laryngoscope"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11356-019-04593-5"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00116109"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","unstructured":"J. Y.Kim Y.Park S. H.Kim S. P.Kim S. W.Park andH. J.Yoon \u201cEffect of Ambient Air Pollutants on the Medical Costs of Allergic Rhinitis in Seoul Korea \u201d133(2023):1828\u20131833.","DOI":"10.1002\/lary.30464"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40471-018-0152-1"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-015-1056-8"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ecoj.12273"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1289\/EHP2732"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2009.05.050"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2020.138579"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.1104349"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10653-018-0190-0"},{"key":"e_1_2_10_23_1","doi-asserted-by":"crossref","unstructured":"Y. M.LiuandC. K.Ao \u201cEffect of Air Pollution on Health Care Expenditure: Evidence From Respiratory Diseases \u201d30(2021):858\u2013875.","DOI":"10.1002\/hec.4221"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.3386\/t0118"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e31828d0590"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/0012-8252(94)90026-4"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40471-020-00243-4"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1386341"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/JCMA.0000000000001242"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.18787\/jr.2024.00023"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.18787\/jr.2025.00012"}],"container-title":["The Laryngoscope"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.70445","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lary.70445","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lary.70445","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T01:47:00Z","timestamp":1783907220000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/lary.70445"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,23]]},"references-count":30,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/lary.70445"],"URL":"https:\/\/doi.org\/10.1002\/lary.70445","archive":["Portico"],"relation":{},"ISSN":["0023-852X","1531-4995"],"issn-type":[{"value":"0023-852X","type":"print"},{"value":"1531-4995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,23]]},"assertion":[{"value":"2025-10-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}