{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:31:04Z","timestamp":1787740264803,"version":"build-2784847793"},"reference-count":36,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,6,6]],"date-time":"2021-06-06T00:00:00Z","timestamp":1622937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Humidifier disinfectant (HD) is a household biocidal product used in humidifier water tanks to prevent the growth of microorganisms. In 2011, a series of lung injury cases of unknown causes emerged in children and pregnant women who had used HD in Korea. This study investigated changes in the nationwide number of cases of humidifier disinfectant-associated lung injury (HDLI) in concordance with nationwide HD consumption using data covering the entire Korean population. More than 25 kinds of HD products were sold between 1994 and 2011. The number of diagnosed HDLI, assessed by S27.3 (other injuries of lungs) of the Korea National Health Insurance Service (NHIS) data, sharply increased by 2005, subsequently decreased after 2005, and almost disappeared after 2011 in concordance with the annual number of HD sales. The number of self-reported HDLIs, assessed using data from all suspected HDLI cases registered in the Korea Ministry of Environment, changed with the annual number of HD sales, with a delay pattern, potentially induced by the late awareness of lung injury diseases. The present study suggests that changes in the nationwide annual consumption of HD products were consistent with changes in the annual number of HDLI cases in Korea.<\/jats:p>","DOI":"10.3390\/ijerph18116136","type":"journal-article","created":{"date-parts":[[2021,6,6]],"date-time":"2021-06-06T23:59:55Z","timestamp":1623023995000},"page":"6136","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Humidifier Disinfectant Consumption and Humidifier Disinfectant-Associated Lung Injury in South Korea: A Nationwide Population-Based Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2717-8370","authenticated-orcid":false,"given":"Jeonggyo","family":"Yoon","sequence":"first","affiliation":[{"name":"Department of Preventive Medicine, Gachon University College of Medicine, Incheon 21999, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9428-0258","authenticated-orcid":false,"given":"Minsun","family":"Kang","sequence":"additional","affiliation":[{"name":"Artificial Intelligence and Big-Data Convergence Center, Gachon University Gil Medical Center, Incheon 21565, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaehun","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Gachon University College of Medicine, Incheon 21999, Korea"},{"name":"Artificial Intelligence and Big-Data Convergence Center, Gachon University Gil Medical Center, Incheon 21565, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Jae","family":"Ju","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Gachon University College of Medicine, Incheon 21999, Korea"},{"name":"Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon 21999, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Hwan","family":"Jeong","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2776-5989","authenticated-orcid":false,"given":"Wonho","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Occupational Health, Daegu Catholic University, Gyeongbuk 38430, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3228-8179","authenticated-orcid":false,"given":"Yoon-Hyeong","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Gachon University College of Medicine, Incheon 21999, Korea"},{"name":"Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon 21999, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,6]]},"reference":[{"key":"ref_1","unstructured":"KCDC (2011). Interim Report of Epidemiologic Investigation of Lung Injury with Unknown Causes in Korean, KCDC. (In Korean)."},{"key":"ref_2","unstructured":"KCDC (2011). Hospital Based Case-Control Study on Lung Injury with Unknown Causes, KCDC. (In Korean)."},{"key":"ref_3","unstructured":"KEITI (2020, December 31). Statistical Data. Available online: https:\/\/www.healthrelief.or.kr\/home\/content\/stats01\/view.do."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2498","DOI":"10.1021\/es300567j","article-title":"Fatal Misuse of Humidifier Disinfectants in Korea: Importance of Screening Risk Assessment and Implications for Management of Chemicals in Consumer Products","volume":"46","author":"Lee","year":"2012","journal-title":"Environ. Sci. Technol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"253","DOI":"10.4491\/eer.2013.18.4.253","article-title":"Refined Exposure Assessment for Three Active Ingredients of Humidifier Disinfectants","volume":"18","author":"Lee","year":"2013","journal-title":"Environ. Eng. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1136\/thoraxjnl-2014-205739","article-title":"Humidifiers: The Use of Biocides and Lung Disease","volume":"69","author":"Pickering","year":"2014","journal-title":"Thorax"},{"key":"ref_7","unstructured":"ACCEH (2021, January 12). Report on Total Sales of Humidifier Disinfectant. (In Korean)."},{"key":"ref_8","first-page":"457","article-title":"An Estimation of Population at Risk of Exposure to Humidifier Disinfectant and Associated Health Effects","volume":"46","author":"Byeon","year":"2020","journal-title":"J. Environ. Health Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s13273-019-0005-0","article-title":"CMIT\/MIT Induce Apoptosis and Inflammation in Alveolar Epithelial Cells through p38\/JNK\/ERK1\/2 Signaling Pathway","volume":"15","author":"Lee","year":"2019","journal-title":"Mol. Cell. Toxicol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1080\/08958378.2019.1624896","article-title":"Guanidine-based Disinfectants, Polyhexamethylene Guanidine-phosphate (PHMG-P), polyhexamethylene biguanide (PHMB), and oligo-(2-(2-ethoxy)-ethoxyethyl) guanidinium chloride (PGH) Induced Epithelial-mesenchymal Transition in A549 Alveolar Epithelial Cells","volume":"31","author":"Park","year":"2019","journal-title":"Inhal. Toxicol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"247","DOI":"10.5668\/JEHS.2017.43.4.247","article-title":"Intra-tracheal Administration of the Disinfectant Chloromethylisothiazolinone\/methylisothiazolinone (CMIT\/MIT) in a Mouse Model to Evaluate a Causal Association with Death","volume":"43","author":"Kim","year":"2017","journal-title":"J. Environ. Health Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1007\/s00204-015-1486-9","article-title":"Polyhexamethylene Guanidine Phosphate Aerosol Particles Induce Pulmonary Inflammatory and Fibrotic Responses","volume":"90","author":"Kim","year":"2016","journal-title":"Arch. Toxicol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1136\/thoraxjnl-2013-204132","article-title":"A Cluster of Lung Injury Cases Associated with Home Humidifier Use: An Epidemiological Investigation","volume":"69","author":"Kim","year":"2014","journal-title":"Thorax"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lamichhane, D.K., Leem, J.H., Lee, S.M., Yang, H.J., Kim, J., Lee, J.H., Ko, J.K., Kim, H.C., Park, D.U., and Cheong, H.K. (2019). Family-based Case-control Study of Exposure to Household Humidifier Disinfectants and Risk of Idiopathic Interstitial Pneumonia. PLoS. ONE., 14.","DOI":"10.1371\/journal.pone.0221322"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Park, J.H., Kim, H.J., Kwon, G.Y., Gwack, J., Park, Y.J., Youn, S.K., Kwon, J.W., Yang, B.G., Lee, M.S., and Jung, M. (2016). Humidifier Disinfectants are a Cause of Lung Injury among Adults in South Korea: A Community-based Case-control Study. PLoS ONE., 11.","DOI":"10.1371\/journal.pone.0151849"},{"key":"ref_16","unstructured":"KCDC (2014). White Paper on the Health Damage Disaster from Humidifier Disinfectants, Ministry of Health and Welfare. (In Korean)."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5668\/JEHS.2017.43.1.1","article-title":"Questions and Answers about the Humidifier Disinfectant Disaster as of February 2017","volume":"43","author":"Choi","year":"2017","journal-title":"J. Environ. Health Sci."},{"key":"ref_18","first-page":"799","article-title":"Data Resource Profile: The National Health Information Database of the National Health Insurance Service in South Korea","volume":"46","author":"Cheol","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_19","first-page":"301","article-title":"Demographic Characteristics and Exposure Assessment for Applicants Who Have Been Injured by Humidifier Disinfectant-Focusing on 4-1 and 4-2 Applicants","volume":"44","author":"Choi","year":"2018","journal-title":"J. Environ. Health Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"351","DOI":"10.4046\/trd.2017.0048","article-title":"Humidifier Disinfectant-Associated Lung Injury: Six Years after the Tragic Event","volume":"80","author":"Kim","year":"2017","journal-title":"Tuberc. Respir. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"251","DOI":"10.3345\/cep.2019.01326","article-title":"The Past, Present and Future of Humidifier Disinfectant-associated Interstitial Lung Diseases in Children","volume":"63","author":"Lee","year":"2020","journal-title":"Clin. Exp. Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1513\/AnnalsATS.201504-221OC","article-title":"Nationwide Study of Humidifier Disinfectant Lung Injury in South Korea.; 1994\u20132011. Incidence and Dose\u2013response Relationships","volume":"12","author":"Paek","year":"2015","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.fct.2014.04.027","article-title":"Polyhexamethyleneguanidine Phosphate Induces Severe Lung Inflammation, Fibrosis, and Thymic Atrophy","volume":"69","author":"Song","year":"2014","journal-title":"Food Chem. Toxicol."},{"key":"ref_24","first-page":"1","article-title":"Assessment of Acute and Repeated Pulmonary Toxicities of Oligo- (2-(2-ethoxy)-ethoxyethyl) Guanidium Chloride in Mice","volume":"8","author":"Song","year":"2020","journal-title":"Toxicol. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.toxlet.2015.01.005","article-title":"The Role of NF-\u03baB Signaling Pathway in Polyhexamethylene Guanidine Phosphate Induced Inflammatory Response in Mouse Macrophage RAW264. 7 cells","volume":"233","author":"Kim","year":"2015","journal-title":"Toxicol. Lett."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1164\/rccm.201504-0768UP","article-title":"Update in Interstitial Lung Disease 2014","volume":"192","author":"Belloli","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"25","DOI":"10.3389\/fmed.2021.595522","article-title":"Role of the Microbiome in Interstitial Lung Diseases","volume":"8","author":"Chioma","year":"2021","journal-title":"Front. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1097\/MCP.0000000000000399","article-title":"The Microbiome in Interstitial Lung Disease: From Pathogenesis to Treatment Target","volume":"23","author":"Salisbury","year":"2017","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Naghavi, M., Richards, N., Chowdhury, H., Eynstone-Hinkins, J., Franca, E., Hegnauer, M., Khosravi, A., Moran, L., Mikkelsen, L., and Lopez, A.D. (2020). Improving the Quality of Cause of Death Data for Public Health Policy: Are all \u2018Garbage\u2019 Codes Equally Problematic?. BMC Med., 18.","DOI":"10.1186\/s12916-020-01525-w"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"427","DOI":"10.3109\/02770909809048951","article-title":"Reasons for Delay in Seeking Treatment for Acute Asthma: The Patient\u2019s Perspective","volume":"35","author":"Janson","year":"1998","journal-title":"J. Asthma."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"400","DOI":"10.4046\/trd.2011.71.6.400","article-title":"Awareness and Impact of COPD in Korea: An Epidemiologic Insight Survey","volume":"71","author":"Hwang","year":"2011","journal-title":"Tuberc. Respir. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Cosgrove, G.P., Bianchi, P., Danese, S., and Lederer, D.J. (2018). Barriers to Timely Diagnosis of Interstitial Lung Disease in the Real World: The INTENSITY Survey. BMC Pulm. Med., 18.","DOI":"10.1186\/s12890-017-0560-x"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Harari, S., Raghu, G., Caminati, A., Cruciani, M., Franchini, M., and Mannucci, P. (2020). Fibrotic Interstitial Lung Diseases and Air Pollution: A Systematic Literature Review. Eur. Respir. Rev., 29.","DOI":"10.1183\/16000617.0093-2020"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1183\/09031936.00122213","article-title":"Acute Exacerbation of Idiopathic Pulmonary Fibrosis Associated with Air Pollution Exposure","volume":"43","author":"Johannson","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1136\/thoraxjnl-2017-209967","article-title":"Role of Atmospheric Pollution on the Natural History of Idiopathic Pulmonary Fibrosis","volume":"73","author":"Nunes","year":"2018","journal-title":"Thorax"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12940-020-00687-7","article-title":"Short-term Exposure to Air Pollution and Hospital Admission for Pneumonia: A Systematic Review and Meta-analysis","volume":"20","author":"Yee","year":"2021","journal-title":"Environ. Health."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/11\/6136\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:11:29Z","timestamp":1760163089000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/11\/6136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,6]]},"references-count":36,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["ijerph18116136"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18116136","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,6]]}}}