{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T01:11:33Z","timestamp":1790039493810,"version":"4.0.1"},"reference-count":52,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2019,9,6]],"date-time":"2019-09-06T00:00:00Z","timestamp":1567728000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003669","name":"Korea Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["#2014ER270501"],"award-info":[{"award-number":["#2014ER270501"]}],"id":[{"id":"10.13039\/501100003669","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Sudden infant death syndrome (SIDS) is an occasional cause of unexpected mortality in infancy. While various etiological factors have been hypothesized, air pollution has been consistently presented as an environmental factor. In this study, we aimed to estimate the risk of SIDS in relation to exposure to air pollution and the effects of its modifying factors. A mortality dataset with supplementary infant mortality survey data from Statistics Korea was used and combined the concentration of ambient air pollution data from AirKorea based on the date of death and residential addresses of the SIDS cases. Odds ratios (ORs) were estimated according to birthweight, gestational age, maternal age, and infant age using a time-stratified case-crossover study design. The risk of exposure to particulate matter of less than 10 \u03bcm in diameter (PM10), nitrogen dioxide (NO2), carbon monoxide (CO), and sulfur dioxide was estimated. The number of deaths due to SIDS was 454 (253 males and 201 females). The OR per 27.8 \u00b5g\/m3 increment of PM10 was 1.14 (95% confidence interval [CI]: 1.03\u20131.25) and that per 215.8 ppb of CO was 1.20 (95% CI: 1.03\u20131.40) in all infants. In females, an increase in NO2 and CO levels was associated with a higher risk of SIDS in low-birthweight and preterm infants. The OR per 15.7 ppb increment in NO2 was highest among preterm infants, with a value of 5.12 (95% CI: 1.27\u201320.63), and low-birthweight individuals, with a value of 4.11 (95% CI: 1.74\u20139.72), at a moving average of 0 to 3 days. In males, however, no significant association was found. In the present study, exposure to air pollution was associated with an increased risk of SIDS. This association was more evident in susceptible infants with a low-birthweight or in cases of preterm birth.<\/jats:p>","DOI":"10.3390\/ijerph16183273","type":"journal-article","created":{"date-parts":[[2019,9,6]],"date-time":"2019-09-06T02:59:22Z","timestamp":1567738762000},"page":"3273","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Ambient Air Pollution and Sudden Infant Death Syndrome in Korea: A Time-Stratified Case-Crossover Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6524-1858","authenticated-orcid":false,"given":"Myung-Jae","family":"Hwang","sequence":"first","affiliation":[{"name":"Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do 16419, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2758-9399","authenticated-orcid":false,"given":"Hae-Kwan","family":"Cheong","sequence":"additional","affiliation":[{"name":"Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do 16419, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4974-5180","authenticated-orcid":false,"given":"Jong-Hun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do 16419, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,9,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1289\/ehp.00108283","article-title":"Associations between mortality and air pollution in central Europe","volume":"108","author":"Peters","year":"2000","journal-title":"Environ. Health Perspect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1136\/oem.59.1.30","article-title":"Associations between daily mortalities from respiratory and cardiovascular diseases and air pollution in Hong Kong, China","volume":"59","author":"Wong","year":"2002","journal-title":"Occup. Environ. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1006\/enrs.2000.4096","article-title":"Air pollution and daily mortality in seven major cities of Korea, 1991\u20131997","volume":"84","author":"Lee","year":"2000","journal-title":"Environ. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1289\/ehp.99107149","article-title":"Air pollution and daily mortality in Seoul and Ulsan, Korea","volume":"107","author":"Lee","year":"1999","journal-title":"Environ. Health Perspect."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1542\/peds.111.2.284","article-title":"Infant susceptibility of mortality to air pollution in Seoul, South Korea","volume":"111","author":"Ha","year":"2003","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1289\/ehp.8484","article-title":"Fine particulate matter (PM2.5) air pollution and selected causes of postneonatal infant mortality in California","volume":"114","author":"Woodruff","year":"2006","journal-title":"Environ. Health Perspect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1542\/peds.114.1.234","article-title":"Sudden infant death syndrome and unclassified sudden infant deaths: A definitional and diagnostic approach","volume":"114","author":"Krous","year":"2004","journal-title":"Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1002\/dev.20369","article-title":"What is the mechanism of SIDS? Clues from epidemiology","volume":"51","author":"Mitchell","year":"2009","journal-title":"Dev. Psychobiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e586","DOI":"10.1542\/peds.113.6.e586","article-title":"Heat stress and sudden infant death syndrome incidence: A United States population epidemiologic study","volume":"113","author":"Schootman","year":"2004","journal-title":"Pediatrics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1111\/ppe.12204","article-title":"A case-crossover study of temperature and infant mortality in California","volume":"29","author":"Basu","year":"2015","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1289\/ehp.97105608","article-title":"The relationship between selected causes of postneonatal infant mortality and particulate air pollution in the United States","volume":"105","author":"Woodruff","year":"1997","journal-title":"Environ. Health Perspect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1542\/peds.2006-0027","article-title":"Air pollution and infant death in southern California, 1989\u20132000","volume":"118","author":"Ritz","year":"2006","journal-title":"Pediatrics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1476-069X-3-4","article-title":"Air pollution attributable postneonatal infant mortality in U.S. metropolitan areas: A risk assessment study","volume":"3","author":"Kaiser","year":"2004","journal-title":"Environ. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1289\/ehp.10370","article-title":"Air pollution and postneonatal infant mortality in the United States, 1999\u20132002","volume":"116","author":"Woodruff","year":"2008","journal-title":"Environ. Health Perspect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1798","DOI":"10.1542\/peds.113.6.e628","article-title":"Air pollution and sudden infant death syndrome","volume":"113","author":"Dales","year":"2004","journal-title":"Pediatrics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1289\/ehp.1002364","article-title":"Survival analysis of long-term exposure to different sizes of airborne particulate matter and risk of infant mortality using a birth cohort in Seoul, Korea","volume":"119","author":"Son","year":"2011","journal-title":"Environ. Health Perspect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1093\/aje\/kwx015","article-title":"Pregnancy and lifetime exposure to fine particulate matter and infant mortality in Massachusetts, 2001\u20132007","volume":"186","author":"Son","year":"2017","journal-title":"Am. J. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.gene.2018.01.034","article-title":"Detoxification genes polymorphisms in SIDS exposed to tobacco smoke","volume":"648","author":"Filonzi","year":"2018","journal-title":"Gene"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1542\/peds.90.6.905","article-title":"Relationship of sudden infant death syndrome to maternal smoking during and after pregnancy","volume":"90","author":"Schoendorf","year":"1992","journal-title":"Pediatrics"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1136\/adc.88.12.1086","article-title":"Adverse health effects of prenatal and postnatal tobacco smoke exposure on children","volume":"88","author":"Hofhuis","year":"2003","journal-title":"Arch. Dis. Child."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1136\/adc.78.4.329","article-title":"A case-control study of smoking and sudden infant death syndrome in the Scandinavian countries, 1992 to 1995","volume":"78","author":"Alm","year":"1998","journal-title":"Arch. Dis. Child."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1203\/00006450-200005000-00015","article-title":"Nicotine delays arousal during hypoxemia in lambs","volume":"47","author":"Hafstrom","year":"2000","journal-title":"Pediatr. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1136\/thx.52.11.1003","article-title":"Passive smoking and sudden infant death syndrome: Review of the epidemiological evidence","volume":"52","author":"Anderson","year":"1997","journal-title":"Thorax"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1164\/ajrccm.152.3.7663813","article-title":"Maternal smoking during pregnancy. Effects on lung function during the first 18 months of life","volume":"152","author":"Tager","year":"1995","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1136\/thx.52.10.905","article-title":"Health effects of passive smoking. 1. Parental smoking and lower respiratory illness in infancy and early childhood","volume":"52","author":"Strachan","year":"1997","journal-title":"Thorax"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1164\/rccm.200411-1586OC","article-title":"Air pollution and child respiratory health: A case-crossover study in Australia and New Zealand","volume":"171","author":"Barnett","year":"2005","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e018341","DOI":"10.1136\/bmjopen-2017-018341","article-title":"Is ambient air pollution associated with onset of sudden infant death syndrome: A case-crossover study in the UK","volume":"8","author":"Litchfield","year":"2018","journal-title":"BMJ Open"},{"key":"ref_28","unstructured":"(2019, June 01). MicroData Integrated Service Website. Available online: https:\/\/mdis.kostat.go.kr\/index.do."},{"key":"ref_29","first-page":"127","article-title":"The factors contributing to the risk of sudden infant death syndrome","volume":"15","author":"Athanasakis","year":"2011","journal-title":"Hippokratia"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1093\/oxfordjournals.aje.a115853","article-title":"The case-crossover design: A method for studying transient effects on the risk of acute events","volume":"133","author":"Maclure","year":"1991","journal-title":"Am. J. Epidemiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1289\/ehp.99107633","article-title":"Reanalysis of the effects of air pollution on daily mortality in Seoul, Korea: A case-crossover design","volume":"107","author":"Lee","year":"1999","journal-title":"Environ. Health Perspect."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"81s","DOI":"10.1183\/09031936.03.00402703","article-title":"Case-crossover design in air pollution epidemiology","volume":"21","author":"Jaakkola","year":"2003","journal-title":"Eur. Respir. J. Suppl."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1289\/ehp.1307960","article-title":"Ambient heat and sudden infant death: A case-crossover study spanning 30 years in Montreal, Canada","volume":"123","author":"Auger","year":"2015","journal-title":"Environ. Health Perspect."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1097\/EDE.0000000000000703","article-title":"Ambient temperature and sudden infant death syndrome in the United States","volume":"28","author":"Jhun","year":"2017","journal-title":"Epidemiology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"108","DOI":"10.3200\/AEOH.63.3.108-113","article-title":"Effects of air pollution on postneonatal infant mortality among firstborn infants in Seoul, Korea: Case-crossover and time-series analyses","volume":"63","author":"Son","year":"2008","journal-title":"Arch. Environ. Occup. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1111\/j.1442-200X.1994.tb03193.x","article-title":"Risk factors for SIDS in Japan: A record-linkage study based on vital statistics","volume":"36","author":"Fujita","year":"1994","journal-title":"Acta Pediatr. Jpn."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1289\/ehp.0900994","article-title":"A growing role for gender analysis in air pollution epidemiology","volume":"118","author":"Clougherty","year":"2010","journal-title":"Environ. Health Perspect."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1542\/peds.96.6.1106","article-title":"Sudden infant death syndrome in relation to weather and optimetrically measured air pollution in Taiwan","volume":"96","author":"Chen","year":"1995","journal-title":"Pediatrics"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1136\/bmj.327.7410.313","article-title":"Interpregnancy interval and risk of preterm birth and neonatal death: Retrospective cohort study","volume":"327","author":"Smith","year":"2003","journal-title":"BMJ"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1046\/j.1365-3016.2001.00330.x","article-title":"Review of risk factors for sudden infant death syndrome","volume":"15","author":"Sullivan","year":"2001","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1136\/oem.56.8.539","article-title":"Pregnancy outcomes and outdoor air pollution: An ecological study in districts of the Czech Republic 1986\u20131988","volume":"56","author":"Bobak","year":"1999","journal-title":"Occup. Environ. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1080\/10473289.2000.10464168","article-title":"Infant mortality and air pollution: A comprehensive analysis of US data for 1990","volume":"50","author":"Lipfert","year":"2000","journal-title":"J. Air Waste Manag. Assoc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1542\/peds.110.5.e64","article-title":"The triple risk hypotheses in sudden infant death syndrome","volume":"110","author":"Guntheroth","year":"2002","journal-title":"Pediatrics"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1542\/peds.2015-2298","article-title":"Overall postneonatal mortality and rates of SIDS","volume":"137","author":"Goldstein","year":"2016","journal-title":"Pediatrics"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"h563","DOI":"10.1136\/bmj.h563","article-title":"Making informed choices on co-sleeping with your baby","volume":"350","author":"Fleming","year":"2015","journal-title":"BMJ"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1056\/NEJM199510123331501","article-title":"Increased maternal age and the risk of fetal death","volume":"333","author":"Fretts","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Kenny, L.C., Lavender, T., McNamee, R., O\u2019Neill, S.M., Mills, T., and Khashan, A.S. (2013). Advanced maternal age and adverse pregnancy outcome: Evidence from a large contemporary cohort. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0056583"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/j.scitotenv.2016.11.090","article-title":"Comparison of diverse estimation methods for personal exposure to air pollutants and associations with allergic symptoms: The Allergy & Gene-Environment Link (ANGEL) study","volume":"579","author":"Kim","year":"2017","journal-title":"Sci. Total Environ."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/0002-9378(71)90926-4","article-title":"Low birthweight and neonatal mortality rate related to maternal smoking and socioeconomic status","volume":"111","author":"Comstock","year":"1971","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/1047-2797(94)90082-5","article-title":"Associations between measures of socioeconomic status and low birthweight, small for gestational age, and premature delivery in the United States","volume":"4","author":"Parker","year":"1994","journal-title":"Ann. Epidemiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1093\/oxfordjournals.aje.a114803","article-title":"The effects of maternal smoking on fetal and infant mortality","volume":"127","author":"Kleinman","year":"1988","journal-title":"Am. J. Epidemiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1097\/01.ede.0000181315.18836.9d","article-title":"Case-crossover analyses of air pollution exposure data: Referent selection strategies and their implications for bias","volume":"16","author":"Janes","year":"2005","journal-title":"Epidemiology"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/18\/3273\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:17:23Z","timestamp":1760188643000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/18\/3273"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9,6]]},"references-count":52,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2019,9]]}},"alternative-id":["ijerph16183273"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16183273","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9,6]]}}}