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- Original Article Risk of non-cancer respiratory diseases attributed to humidifier disinfectant exposure in Koreans: age-period-cohort and differences-in-difference analyses
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Jaiyong Kim1
, Kyoung Sook Jeong2
, Seungyeon Heo3
, Younghee Kim4
, Jungyun Lim4
, Sol Yu4
, Suejin Kim5
, Sun-Kyoung Shin5
, Hae-Kwan Cheong6
, Mina Ha7
, Epidemiology Expert Committee for Reviewing the Epidemiological Correlations between Humidifier Disinfectant Exposure and Health Effects -
Epidemiol Health 2025;47e2025006-0
DOI: https://doi.org/10.4178/epih.e2025006
Published online: February 22, 2025
2Department of Occupational and Environmental Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
3Environmental Health Big Data & Environmental Health Center, Wonju Severance Christian Hospital, Wonju, Korea
4Humidifier Disinfectant Health Center, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
5Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea
6Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
7Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
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Corresponding author:
Hae-Kwan Cheong,
Email: hkcheong75@gmail.com
Mina Ha,
Email: minaha@dku.edu
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Abstract
OBJECTIVES
Humidifier disinfectants (HDs) were sold in Korea from 1994 until their recall in 2011. We examined the incidence patterns of 8 respiratory diseases before and after the HD recall and estimated the attributable risk in the Korean population.
METHODS
Using National Health Insurance data from 2002 to 2019, we performed age–cohort–period and differences-in-diffference analyses (comparing periods before vs. after the recall) to estimate the population-attributable fraction and the excess number of episodes. The database comprised 51 million individuals (99% of the Korean population). The incidence of 8 diseases—acute upper respiratory infection (AURI), acute lower respiratory infection (ALRI), asthma, pneumonia, chronic sinusitis (CS), interstitial lung disease (ILD), bronchiectasis, and chronic obstructive pulmonary disease (COPD)—was defined by constructing episodes of care based on patterns of medical care and the clinical characteristics of each disease.
RESULTS
The relative risks (RRs) for AURI, ALRI, asthma, pneumonia, CS, and ILD were elevated among younger individuals (with an RR as high as 82.18 for AURI in males), whereas chronic conditions such as bronchiectasis, COPD, and ILD showed higher RRs in older individuals. During the HD exposure period, the population-attributable risk percentage ranged from 4.6% for bronchiectasis to 25.1% for pneumonia, with the excess number of episodes ranging from 6,218 for ILD to 3,058,861 for CS. Notably, females of reproductive age (19-44 years) experienced 1.1-9.2 times more excess episodes than males.
CONCLUSIONS
This study provides epidemiological evidence that inhalation exposure to HDs affects the entire respiratory tract and identifies vulnerable groups.
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